PHA STICKS & PUCKS WAIVER & COVID Screening Form
PHA Sticks & Pucks

1. Each session will be monitored by 1 or more PHA certified coach(s) within the session age group.

2. Parents of participants are REQUIRED to sign the Assumption of Risk waiver and a adult must stay on the premises of the Plymouth Cultural Center for the duration of their participants time on the ice that will be responsible for that player.

3. Players must sign in and pay the appropriate fees before going on to the ice. Players that fail to do so will be asked to leave the ice.

4. Stick & Puck sessions are intended for shooting, passing, and stick handling skill development. These sessions are not for Pick-Up hockey. There will be no scrimmages, games, one-on-ones, two-on-ones, drills etc.

5. Full equipment is required for ages 17 and under. For ages 18 and over, full equipment is highly recommended. The minimum equipment required for ages 18 and over is a helmet (facemasks are strongly recommended), shin pads, sticks, and gloves.

6. No players may take off his/her helmet or raise their facemask while on the ice or in the bench area.

7. No one may assume the role of playing goalie without wearing ALL of the appropriate goalie equipment.

8. Care and right of way must be given to coaches and their student.

9. No food, gum, or usage of chewing tobacco is allowed on the ice.

10. No spectators are allowed in the bench area.

11. All doors are to remain closed while pucks are on the ice.

12. Pucks must be picked up by the end of the session. Nets are to be pushed to the exit door, where the nets are stored by the end of the session.

13. Players may not involve themselves in any activities which would alter the ice surface or damage the rink facility.

14. Rude or unsportsmanlike behavior and/or language will not be tolerated and may result in expulsion from the ice. Management reserves the right to terminate the disruptive or rude behavior.

15. Players may be expelled from the ice without refund or credit by Cultural Center staff for reasons including, but not limited to disruption and hazard.
     
16. Limited to a maximum of 20 PHA skaters (including goalies) on a first-come, first-serve basis.

                                           HOLD HARMLESS and INDEMNIFICATION AGREEMENT

Plymouth Cultural Center, Plymouth Department of Parks & Recreation, and Plymouth Department of Parks & Recreation, and the Plymouth Hockey Association.

Assumption of Risk

I am aware that ice sport activities involve certain inherent risks, dangers, and hazards, which can result in serious personal injury or death. I am also aware that ice rinks contain dangers that can cause serious injury or death. I hereby freely agree to assume and accept all known and unknown risks of injury arising out of ice-skating activities. I recognize and acknowledge that risks of any activity at the Plymouth Cultural Center can be greatly reduced by taking lessons, abiding by the PHA Code of Conduct and using common sense.

Waiver and Release of all Claims and Assumptions of Risk

Please read this form carefully and be aware that in signing up and participating in sticks and pucks at the Plymouth Cultural Center, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity. I recognize and acknowledge that there are certain risks of physical injury to participants in any activity at the Plymouth Cultural Center, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child may have (or accrue to me, my child) as a result of participating in any activity at the Plymouth Cultural Center against the Plymouth Cultural Center, the City or Plymouth, and the Plymouth Hockey Association, including its elected or appointed officials, managers, agents, volunteers and employees.

I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

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Email *
Participant's Name *
Participant's Legal Guardian Signature *
PHA Team / Coach *
Date *
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Name of Adult on Site w/ Participant *
Do you have any of the following COVID-19 symptoms? (Where you cannot attribute the symptoms to another health condition.) *
If the answer to any of the questions above is "YES", stay home and consult your primary care physician. If a doctor determines that the symptoms are due to another diagnosis, or COVID-19 is ruled out, you may return to activity after being fever-free for 24 hours without the use of fever-reducing medications. *
If you have answered "YES" to either of these questions, you must stay home to quarantine for 14 days since last contact or return to the US.
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