K-W SIDEWINDERS REGISTRATION FORM 2015/16
Name: ____________________________________________________________
Address: ___________________________________________________________
Phone #: _______________________
E-mail: ______________________
Division: _________________
Cell #: __________________________
Business #:_________________________
Disability:_________________________________
Special Medical Conditions:_____________________________________________
Date of Birth:
(month/day/year)_____________________________________________________
Parent or Guardian’s Name if under 18____________________________________
Parent or Guardian’s Contact Address / phone #:____________________________
Tournaments: Are you willing to travel to tournaments in other cities, possibly staying
over night? Yes
No
(We need to know for numbers for booking team participation in tournaments and hotel rooms.)
Safety Waiver:
I understand that it is my responsibility to wear all required safety equipment. While on
the ice, all players must wear a C.S.A. approved hockey helmet to which a C.S.A.
approved facial protector must be securely attached and not altered in any way. All
players must also wear shoulder pads, elbow pads, a throat guard and shin guards.
Signature of Player or Guardian:
Permission to use player’s picture in advertisements for the Sidewinders:
Yes
No
Kitchener Waterloo Sidewinders Sledge Hockey Club
871 Victoria St N suite 7B-236
Kitchener ON N2B 3S4
Phone #: 519-274-2584 (Brian Steele cell)
E-mail: kwsidewinders@gmail.com
www.kwsidewinders.com
We need your complete address with postal code and your complete phone
number with area code. Please note, you will be meeting with your coach and
trainer at the beginning of the season to discuss any pertinent medical
information you may have concerning your disability.
KW SIDEWINDERS REGISTRATION 2015/16 SEASON
Our first ice time back at RIM PARK, PLEASE bring with you, your sledge and all
your equipment to make sure that it is up to date and fits for the coming season. If
you are in need of a new sledge & equipment or modifications please come 1 hour
early for your ice time.
If you have an e-mail address that you check regularly and would like to receive
information vie e-mail instead of in the mail or by phone, please include you e-mail
address on the registration form. This will be used to contact you with tournament
information, schedule changes, meetings and social/ party information.
Our website is being run by Jason Ryan this year. You can find registration form,
pictures from tournaments of the players, team rosters, about each complex we play at
and directions to away games. You can find the website at www.kwsidewinders.com.
Please note that EVERYONE must complete a registration form BEFORE being
permitted on the ice. Except new players that can try out our sport for 2 weeks at no
cost.
Please note that the ice times will stay the same as last year. The development will be
1:00 - 2:00pm they can stay out as long as they like and practice with Intermediates will
be on the ice from 2:00 - 3:50pm. This change was mandated by the City of Waterloo to
improve ice conditions for those following us.
Our club relies on everyone to contribute their time in some way be it with fund raising,
weekly bingo’s, being a timekeeper, or organizing a party. Volunteering is an economical
way of reducing registration costs while continuing to enjoy benefits not offered by other
clubs. (i.e. parties, trips, and hotel rooms)
Note:
If you have Club equipment such as sleds, sticks, equipment, etc. and are not using
could you please return it to the Club. Call 519-274-2584 to make arrangements for its
return or purchase. Return equipment can be utilized by other players or newly
interested individuals. Our limited budget enables us to loan club equipment on a
temporary basis. We will be contacting families if we do not hear from you. Your
cooperation is much appreciated.
Here are the board contacts:
Member’s Name
Brian Steele
Kris Dutkiewicz
John Crawford
Steve McCutcheon
Kevin Sorley
Jason Ryan
Doug McArter
Position
President
Vice President & Coaches Rep
Secretary & Treasurer
Executive Member
Executive Member
Executive Member
Executive Member
REGISTRATION COSTS 2015/16
Registration fees for this regular playing season are based on flat fee system.
We would like 1 cheque for the year. If you cannot afford to pay it all at once or would
like help with your fees please send a letter to the board with your request. The
insurance is part of the registration cost.
Novice/ Junior Fees: 16 years of age and under only
Insurance
Total Novice /Junior Fee
$30.00
$300.00 (includes insurance)
Novice / Junior Recreation Fees:
For players interested in only recreational play.
Recreational play is based on:
- Can play season home games if approved by coach
- Can NOT play at away games or tournaments.
Insurance
Total Novice / Junior Recreation Fee
$30.00
$75.00 (includes insurance)
Intermediate/ Senior Fees: 17 years of age and over
Insurance
Total Intermediate/ Senior Fee
$30.00
$400.00 (includes insurance)
Intermediate travel team rosters spots are subject to availability & commitment. We may
have two teams if numbers permit. We require commitment from players to play the full
season & attend most practices.
Intermediate/ Senior Recreational Fees:
For players interested in only recreational play.
Recreational play is based on:
-Can NOT play home games
-Can NOT play at away games or tournaments
Insurance
Total Intermediate / Senior Recreational Fee
$30.00
$200.00 (includes insurance)
Note to All Players: All players must have registration fees and paperwork completed
before entering ice surface.