Manitoba Ball Hockey
Association
306-145 Pacific Street
Winnipeg, Manitoba
R3B 2Z6
(204) 925-5602
E-mail [email protected]
www.manitobaballhockey.com
Please Print
Jersey
Last Name
#
First Name
Team Name_____________________________________________
Winter 2016-17 Roster Form and Waiver Agreement - Please read before you sign.
Home Address
Postal
Phone
E-mail address
Birth Date
Code
Number
D/M/YR
Signature
Upon Signing this roster form and waiver agreement I hereby agree to abide by all the rules, regulations, and decisions of the Manitoba Ball Hockey Association, and the Winnipeg Ball Hockey League.
For valuable consideration, the receipt whereof is hereby acknowledged, the undersigned does hereby for himself/herself his heirs, executors, administrators, successors and assigns release and forever
discharge the Manitoba Ball Hockey Association and the Winnipeg Ball Hockey League from any and all actions, causes of action, claims and demands for, upon or by reason of any damage, loss or
injury to person and property which heretofore has been hereafter may be sustained in consequence of the undersigned’s participation as a player in the Manitoba Ball Hockey Association during the
2016-17 Winter Ball Hockey season and without limiting the generality hereof,whether sustained in try-out camp,practice,reguler league, playoff, tournament or exhibition games against league or non
league teams, and travel to and from the location of participation.
Dated in the City of Winnipeg, in the province of Manitoba,
This__________ day of ___________________, 2016
Team Name ______________________________
Signature of Team Captain/Representative_____________________________ Print Name ______________________________