Mighty Ducks Hockey League

Registration Form

Player’s First Name:

Last Name:

street address:

City:

Zip Code:

Birth Date(mm/dd/yyyy):

Gender: Female Male

Pre-School: 1st 2nd 3rd 4th 5th

Which elementary school do you live near? Closest School:

What position(s) do you normally play? (check all that apply)

Forward Defense

Midfield Goalkeeper

Uniform Size:

Youth Smal Medium

Youth Medium Small

Youth Large Large

Extra-Large

Permission to Play

I, the parent or guardian of the minor registrant, agree that the registrant and I will abide by all the rules of the Mighty Ducks Hockey League (MDHL). In recognizing the possibility of physical injury associated with hockey and in consideration for the “League" accepting the registrant for its hockey programs and activities, I hereby release, discharge, and/or otherwise indemnify MDHL, their employees and associated personnel and voIunteers,incIuding the facilities used for practices and games, against any claim by or on behalf of the registrant as a result of the registrant's participation in the programand/orbeing transported to or from MDHL sponsored activities,which transportation By signing below, I herebyagree andauthorizethe above.In addition, By entering your name below, lalso acknowledge that I have read the cancellation policy and agree to its terms.

Parent/GuardianSignature:

Date: