WPHU Junior Hockey Registration Oct/Nov 2015
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Child's Name *
Child's Surname *
Age Group 2015 *
Age Group 2016 *
Did you play school hockey this year *
Required
If "YES" what team did you play for ? *
Please select if this applies to your child
Parent / Guardian Name & Surname *
Parent / Guardian Contact Number *
Email Address *
Cell Number *
Medical Conditions *
Please list any medical conditions and/or chronic medication that your child uses
Emergency Contact Name & Number *
Contact details for an alternative person in the event the parent is not available
Indemnity *
As the legal guardian of the above mentioned dependent, in consideration of being allowed to participate in the activities and program of WP Hockey Union’s Junior Hockey Programme, and to use its facilities and equipment, I do hereby waive, release, and forever discharge WP Hockey Union and its members, coaches, employees, representatives, and all others from any and all responsibilities or liability from injuries or damages resulting from his/her participation in any activities.  I understand and am aware that the playing of hockey and the use of the associated equipment is a potentially hazardous activity. I also understand that fitness activities involve a risk of injury and even death, and that I am voluntarily allowing participation in these activities and the use of the equipment and facilities with knowledge of the danger involved. I hereby agree to expressly assume and accept any and all risks of injury or death.   I do hereby further declare that the above mentioned dependent to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent his/her participation or use of equipment except as stated above. I affirm that I am of legal age and am the legal guardian of the above mentioned dependent and am freely signing this agreement.  I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies, which may be available to me for the ordinary negligence of WP Hockey Union or any of the parties listed above.
Required
Payment Details
The payment of R600 per child is to be made to the following account : FNB – Mowbray Branch Code:  200309 Acc No : 5007 225 1298 Acc Name : Western Province Hockey Union Acc Type : Chq Acc - Reference must please be your childs initial and surname and JHP eg : CWheelerJHP - Proof of payment MUST be emailed to juniorhockey@wphockey.org.za
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