2021 Powerskating Contact Form (Top Shelf Hockey)

Print 2021 Powerskating Contact Form
Player Info
  1. First, Last
  2. RadDatePicker
    Open the calendar popup.
  3. Primary email to be used for communication
  4. Please be honest
Parent / Guardian Info
  1. if different from above
  2. Example: ###-###-####
  3. Home, other parent, etc
Additional Info
Line Requests, Team Request, Health Issues, etc
  1. Line Requests, Team Request, Health Issues, etc
  1. 1.  I, being the parent or legal guardian of the child hereon registered, do authorize by my signature below to permit TOP SHELF HOCKEY and their staff to seek out and obtain any necessary medical attention in the case of accident or injury during the program. It is further agreed that the operators of this hockey program are released from and all claims from damage that may arise from any accident, injury, death, damage or loss, which is caused by or arises from participation of the applicant hereon during the program or in any location where the program is being held.

    2.  TOP SHELF HOCKEY has my permission to use photographs which may include my child publically for promotional purposes. I understand that these images may be used in print publications, the topshelfhockey.net website, and social media applications. I also understand that no royalty, fee or other compensation shall become payable to myself or my child by reason of such use.

Human Validation