Pines Ice Arena
12425 Taft St Pembroke Pines, FL 33028
(954) 704-8700 www.PinesIce.com
Player Information
Child’s Name: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____
Address: ____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____
City: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ __ ST: ___ ___ Zip: ___ ___ ___ ___ ___
Home Phone: ___ ___ ___ ___ ___ ___ ___ ___ ___ ____ Cell: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Birth date: _____ / _____ / _____
Are you a new player at Pines Ice Arena?
Ice Hockey Experience:
Recreational
Travel
Yes
Position:
No
Forward
Defense
Goalie
USA Hockey Information
Confirmation # (located under barcode): ____________________________________
Parent Information
Mother’s Name: ___________________________ Father’s Name: _______________________________
Is parent interested in coaching?
Yes
No
If yes, does parent skate?
Yes
No
Email Subscription
Sign up to our Youth Hockey Email Subscription to receive all league information by email. Stay in the loop and receive
schedules, any changes and other league information directly to your inbox. You can sign up for free on our website
www.PinesIce.com at any time by clicking “Youth Hockey Subscription” under the Hockey tab.
League Information
Division:
Mite
Squirt
Peewee
Bantam
Midget
(Must fill out another form if playing in multiple divisions)
Jersey Size: Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Specific Request (not guaranteed):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Liability Waiver
I do hereby acknowledge that skating is a dangerous sport, physically demanding and highly competitive. I hereby agree that Florida Ice Arena,
Inc. its servants, agents and employees shall not be held liable for any and all injuries/losses resulting directly or indirectly and save Ice Arenas
of Florida, Inc. its servants, officers, agents and employees harmless from all cases and expenses that may result from any breach of agreement.
I also agree to the Pines Ice Arena Youth In-House Hockey Policy on file at Pines Ice Arena and located on the back of this registration form.
Parent/Guardian Signature: ______________________________________________ Date: _____ / _____ / _____
Participant Signature: ___________________________________________________ Date: _____ / _____ / _____
____________________________________________________________________________________________________________________________________________________________
Registration Information (For Office Use Only)
USA HOCKEY CONFIRMATION 
PIF 
DIVISION: _______________ TEAM: _______________
Payment Date
Amount
CASH/CC/CHECK#
RECEIPT #
INITIALS
Pines Ice Arena
Youth In-House Hockey Policy
Summer 2016
Website: www.PinesIce.com
Email: [email protected]
Pines Ice Arena’s Summer Youth Hockey League will begin June 12th, 2016 and will end with
championships in August.
REGISTRATION FORMS WILL NOT BE ACCEPTED IN THE FRONT OFFICE WITHOUT USA HOCKEY
CONFIRMATION. You can register for USA hockey at www.usahockeyregistration.com. Please print out
the confirmation and turn in with your registration form or write the confirmation # on the space
provided.
Summer 2016 Season Fees
Full Season Player Fee: $280.00 per player if registered after June 12th, 2016
Early Bird Player Fee: $250.00 per player if registered before June 12th, 2016
Goalie Fee: $200.00
USA Hockey Birth Date Guidelines
(All League divisions will be established under these guidelines)
Mite: 2007 and younger Squirt: 2005/2006
Peewee: 2003/2004 Bantam: 2001/2002 Midget: 1999/2000
Evaluations
Mite: Sunday, June 12th, 2016 @ 9:10am
Squirt: Sunday, June 12th, 2016 @ 10:20am
Peewee: Sunday, June 12th, 2016 @ 11:30am
Bantam: Sunday, June 12th, 2016 @ 12:40pm
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The season will begin with evaluations and clinics. All players are required to attend both the evaluation
and clinic.
The season fee covers 10 games, 1 jersey and 1 guaranteed playoff game. There are no practices during
the summer season.
Registration forms will not be accepted in the office without USA hockey confirmation. No exceptions.
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Registration forms will be accepted in the office beginning May 22 , 2016. A parent or guardian must be
present to sign all appropriate paperwork.
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Team drafts will take place June 12 , 2016 – June 17 , 2016.
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All players will be notified of their team placement by 9:00pm on Friday, June 17 , 2016. Games will
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begin Sunday, June 19 , 2016.
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Registration forms received after June 12 will not be guaranteed IMMEDIATE placement, but will be
placed on teams as soon as possible.
Pines Ice Arena reserves the right to alter team rosters AT ANY TIME during the course of the season to
aid in league balance.
Games will be scheduled on the weekdays between the hours of 6:00pm and 9:00pm or on the weekends
between the hours of 7:00am and 7:00pm.
Consideration is made for the ages of players when the ice schedule permits.
Goalie policy: 2 goalies per team depending upon the demand.
There are no refunds.
We cannot guarantee any specific requests including but not limited to coach preference, player
preference and carpool situations.