Registration and Medical Information Form
Clavet Minor Hockey
Player's First Name
Your answer
Player's Last Name
Your answer
What DAY, MONTH and YEAR Were You Born ? (Be sure to Choose the correct YEAR or it defaults to 2018.)
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Click Here to CHOOSE Age Group: Age division is based on player's age as of Dec. 31st of the current hockey season. * Note these fees below include your team startup fees AND $160 bingo deposit.
Players Prefered Position (atom and higher)
Mailing Address
please include postal code
Your answer
Physical Address
house address or legal land location
Your answer
Parent 1 Full Name
Your answer
Parent 1 Email Address
Your answer
Parent 1 Main Phone Number
Your answer
Parent 2 Full Name
Your answer
Parent 2 Email Address
Your answer
Parent 2 Main Phone Number
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Player's School
Your answer
Last Team and Year Played
Your answer
Player Medical Information
Health Insurance Number
Your answer
Doctor's Name
Your answer
Doctor's Number
Your answer
Dentist's Name
Your answer
Dentist's Number
Your answer
Medical History and Conditions
check the boxes that pertain to the player you are registering
Please give details below if you checked any of the boxes above.
Your answer
Medications
Your answer
Player can carry and administer their own medications
Allergies
Your answer
Previous Injuries
Your answer
Medical Conditions
Your answer
Last tetanus shot
MM
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DD
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YYYY
Date of last physical examination
MM
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DD
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Any information not covered above.
Your answer
Medical Parental Agreement
* Any medical condition or injury problem should be checked by your physician before participating in a hockey program.
I understand that it is my responsibility to keep the team management advised of any change in the above information as soon as possible and that in the event no one can be contacted, team management will take my child to hospital/M.D. if deemed necessary. I hereby authorize the physician and nursing staff to undertake examination investigation and necessary treatment of my child. I also authorize release of information to appropriate people (coach, physician) as deemed necessary. The player parents and/or guardians agree that the players skates at his or her own risk and agree that the Clavet Minor Hockey Association, the instructors, the Clavet Arena Association, and the Village of Clavet are not liable nor will be held responsible for any accident to the player or other players, or loss or damage to personal property, however caused, and agree to release the above Associations from all claims and damages.
Name
Your answer
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Photo Consent
I hereby consent to the collection and use of any photographic images or video recordings that include the registered player. I acknowledge these may be used on the clavet minor hockey association website, in newsletters and publications as well as distributed to members. I understand that no personal information, such as full names, will be used in any publications unless express consent is given. I also understand that my consent can be withdrawn at anytime in writing to: Clavet Minor Hockey Association, Box 74 Clavet, Sk, S0K 0Y0
Parental Agreement
Code of Conduct Agreement
Cougar parents are held accountable for their behaviour. Set a positive example by displaying respect for players, coaches, opponents, officials, and the game of hockey by cheering with class. Cheer for the whole team, encourage them to hustle and try their best. Negative or abusive behaviour or language is not tolerated. !

Cougar parents are fans and let the coaches do the coaching. Instructions yelled from the stands often confuse players, and may actually be counter productive to what the coaches have instructed the player to do. Parents need to understand that individual player ice times will rarely if ever equal out in a game. Parents value the contribution of the coach in developing a player’s talents, even though I may not always
agree with their methods. !

Officials are to be respected at all times. They make mistakes… so do the rest of us. Criticism from the stands does not reflect our team concept and is not tolerated. !

Cougar parents are on time. Ensure your player is at the rink early enough so they can be ready to go before the scheduled practice or game, so the coaches can prepare a line-up, address the practice/game plan and complete a thorough warm-up. Please call in advance if your player is unable to attend a game or practice. Specific team rules regarding when players are expected to be at the rink will be set by the
coaches. !

Cougar players are privileged to play hockey. They wear the Cougar jersey with pride and class. Jerseys are always carried on a hanger. Encourage them keep their uniforms and equipment clean. !

All parents will adhere to the 24 hour “cool-down” rule. If a parent is upset following a game or practice, they will wait 24 hours before addressing the manager regarding their concern. The manager will then discuss the concern with the coach. If you feel your concern is not met then bring it to the attention of the CMHA Executive. !

Ultimately, regardless the competitive level of play, Cougar parents need to encourage their player to put forward their best effort and have fun playing the great game of hockey.

I agree to abide by the principles of this Code of Conduct Agreement as set by CMHA and supported by Hockey Canada. I also agree to abide by the rules, regulations and decisions as setfor the Clavet Minor Hockey Association. !I understand that CMHA, or its individual executive members or teams officials, cannot be heldfinancially or legally responsible in any manner. !I realize that any breach of the above mentioned agreement or Association bylaws and policy mayresult in disciplinary action up to or including removal from the Association without refund at thediscretion of the CMHA Executive.
Name
Your answer
Date
MM
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