REGISTRATION FORM
COMPLETE FULLY, SIGN, & RETURN WITH ENTRY FEE TO:
RIHL, 137 VILLAGE BLVD, PERRY, GA 31069

NAME:_________________________ PHONE #:______________ DOB:_____________
ADDRESS:_______________________________________________________________
CITY, STATE, ZIP:_________________________________________________________
MAJOR MEDICAL INSURANCE? (Y/N) ________ POLICY #_____________________
NAME OF INS. COMPANY AND AGENT:_____________________________________

I CONSIDER MYSELF A: BEGINNER INTERMEDIATE ADVANCED PLAYER (circle 1)

WAIVER: I know that playing inline hockey is a potentially dangerous activity. I should not enter this league unless I am medically able and properly trained. I also assume any and all other risks associated with this league including, but not limited to, falls, contact with other pariticipants, the effects of weather (including high heat and/or humidity), and the condition of the rink, all risk being known and appreciated by me. Knowing these facts and in consideration of your acceptance of my entry fee, I hereby for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf agree not to sue, and release any organization associated with the league from any and all claims or liability for death, personal injury or property damage of any kind or whatsoever arising out of, or in the course of my participation in this league. The release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned further grants full permission of this league and any organizations conducting the league and/or agents authorized by them to use any photographs, videotapes, motion pictures, recording, or any other record of this league for any purpose.

I have read the foregoing and certify my agreement:__________________________________

If registrant is under 18, parent or guardian signature:_________________________________