INT
RAMURAL ICE HOCKEY
REGISTRATION FORM
Name: ___________________________Email Address: ____________________@flemingc.on.ca
FLEMING EMAIL ADDRESS ONLY
MALE or FEMALE (Please circle)
Student Number: ___________________ Phone: _____________________Age: ______
Would you be a Team Captain?
Yes ______
No _______
PLEASE READ & ANSWER CAREFULLY
ARE YOU A REGISTERING AS A GOALIE?
YES______
CAN YOU PLAY OUT AS WELL AS GOALIE?
YES______ NO______
YOU MUST HAVE YOUR OWN EQUIPMENT TO BE A GOALIE
Position that you can/will play: Defence ______
Forward_________
WAIVER:
Participation in athletic and recreation activities involves the risk of personal injury. The use of equipment, facilities and premises
of Fleming College (The College) by persons participating in athletics and recreation activities shall constitute acceptance of that
risk regardless of the nature of the injury. The college, its officers, employees and agents shall not be liable for any injury, loss or
damage sustained or suffered by persons participating in athletics or recreation activities on or off Fleming college property,
whether caused directly or indirectly by the negligence or fault of the College, its officers, employees or agents or otherwise.
Participants with conditions that may be aggravated by participation in this event (examples: epilepsy, heart conditions, joint
problems, a state of poor physical fitness, etc.) should check with their physician before entering Fleming Intramural programs.
PLAYERS NOT ON TEAM ROSTERS AT THE TIME OF REGISTRATION MUST REGISTER WITH THE RECREATION
DEPARTMENT TO BE ELIGIBLE TO PLAY.
YOUR SIGNATURE GIVES THE ATHLETIC/RECREATION DEPARTMENT PERMISSION TO VERIFY YOUR ENROLLMENT
FOR ELIGIBILITY AND TABULATION OF INTRAMURAL POINTS.
Photograph Permission
Pursuant to section 39(2) of the Freedom of Information and Protection of Privacy Act,
I, ____________________________________________________ hereby consent to:
a)
b)
the use of personal information obtained during this interview, and
the use of any supplemental personal information pertaining to the initial interview which may be needed by the College
at a later date; and
c)
the use of any photographs or videotape taken by College personnel or by individuals contracted by the College for such
purpose.
I understand that my personal information will be used for promotional purposes which include College publications, broadcasts,
website and / or use by the public media when that media requires my information in connection with the printing / broadcasting /
web posting of College-related publicity.
The legal authority for the collection of this information is the Ministry of Colleges and Universities Act. R.S.O. 1980, C.272
___________________________________
______________________________
Signature
Date
OFFICE USE ONLY
Amount Paid: ______ Payment Type: ________
Please complete other side
Receipt #: ________
Staff Initial: ________
FOR RIDE PURPOSES ONLY
You may write the names of TWO (2 only) intramural hockey players.
WE WILL TRY OUR BEST TO ACCOMMODATE YOUR REQUEST.
Both players must make a mutual request.
1.______________________________________
2. ______________________________________
Maximum of 3 players to be drafted together
ALL 3 PLAYERS MUST HAVE EACHOTHERS NAMES ON THEIR SHEET
These players must register at the same time and the forms will go together in the draft as a whole.
If you have requested to be drafted with any other player – and it is not a mutual request, or you did
not register together you will considered as an individual.
NO EXCEPTIONS!
USE OF NECK GUARDS ARE MANDATORY
WAIVER FORM MUST BE COMPLETE IF YOU ARE
USING A HALF FACE MASK IN PLACE OF FULL FACE MASK
INTRAMURAL ICE HOCKEY
Name: ___________________________________ Student No.:________________ Gender:______________
__________________________________________________________________________________________
Peterborough Address – While attending College
Postal Code
__________________________________________________________________________________________
Home Address
Postal Code
Peterborough Phone No.: (____)_______________
Home Phone No.: (____)________________________
Program: __________________________________
Length of Program: ____________________________
Sport:
Health Card No.: ____________________________
__________________________________
Participation in athletics and recreation activities involves the risk of personal injury. The use of the equipment, facilities
and premises of Sir Sandford Fleming College (“the College”), any persons participating in athletics and recreational
activities shall constitute acceptance of that risk regardless of the nature of the injury. The College, its officers,
employees and agents shall not be liable for any injury, loss or damage sustained or suffered by persons participating
in any athletics or recreational activities at the College, whether caused either directly or indirectly by the negligence or
fault of the College, its officers, employees, agents or otherwise.
_________________
Date
_________________________________________
Signature (Athlete)
___________________________
Witness