Mass Model Skills & Tournament (Summer) Registration Form

Player Information

First Name *

Last Name *

Date of Birth

Email Address *

Confirm Email Address *

Player Position *
Forward Defence Goalie

Telephone *

Street Address *

City *

Province / State *

Postal / Zip Code *

Parent / Guardian Information

Name *

Email *

Confirm Email Address *

Home Phone *

Work Phone *

Mobile Phone *

Insurance Company *

Policy # *

Current Team

Payment Options:
Pay Total: $389.00 USD
Pay Deposit: $389.00 USD

Additional Items

Item	Price	Quantity
Payment Refund Insurance	$35.00

* to purchase Payment Refund Insurance please enter a 1 for Quantity

Payment Refund Insurance
Payment refund insurance is available at an additional $35. Enrollment is limited and sales are considered final. This insurance must be purchased at the time of registration and the $35 will not be included in the reimbursement. Hub City Hockey, LLC must be notified with confirmation before the programs begins allowing the participant complete reimbursement. Refunds will not be afforded without the purchase of such insurance. (Insurance is optional, but recommended).

Release of Liabililty/Acknowledgement of Risk
Upon entering events sponsored by Hub City Hockey, LLC/BIA. I/We understand and appreciate that participation or observation of the sport of hockey constitutes a risk to me/us of serious injury, including permanent paralysis or death. I/We voluntarily and knowingly recognize accept and assume this risk and release Hub City, LLC/BIA, its affiliates, their sponsors, event organizers and officials from any liability therefore. Players choosing to play without a mask do so at their own risk.

Please check if you agree to the above terms.

(Fields marked with a * are required)