Walk In's Registration: LaCouture Hockey Summer Skills-2023

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Player Registration

Discipline, Dedication,Desire, and Hard Work Will Deliver Results:

Player Name: *

Player USA Hockey Number: *

Player Birth Year: *

Team 2022-2023 Season *

Registering for Tuesday Skills: *

TUESDAYS 6:40pm (Ages 5 thru 12 (Boys and Girls)

TUESDAYS 7:40pm (Ages 12 and UP (Boys and Girls)

Payment Option: *

Check Payable to LaCouture Hockey ($40.00) per session

Venmo @LaCoutureHockey ($40.00) per session

What skills does your child need to improve on *

Parent's Name: *

Parent's Contact Information: *

Parent's E-Mail: *

Emergency Contact Name: *

Emergency Contact Information: *

Emergency Contact E-Mail: *

Allergies or Medical Conditions: *

Any other important information *

Covid-19 Liability Release. The coronavirus, Covid-19, has been declared a worldwide pandemic by the World Health Organization. Covid- 19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. LaCouture Hockey LLC has put in place preventative measures to reduce the spread of Covid-19, however, LaCouture Hockey LLC cannot guarantee that you or your child(ren) will not become infected with Covid-19. Further, attending LaCouture Hockey LLC could increase your risk and your child(ren)’s risk of contracting Covid-19. By registering for LaCouture Hockey, I acknowledge the contagious nature of Covid-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by Covid-19 by attending LaCouture Hockey and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by Covid-19 at LaCouture Hockey may result from the actions, omissions, or negligence of myself and others, including, but not limited to LaCouture Hockey LLC owners, employees, and other participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury,disability and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at LaCouture Hockey or participation LaCouture Hockey LLC’s programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of a relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence LaCouture Hockey LLC, its owners, employees, agents, and representatives, whether a Covid-19 infection occurs before, during, or after participation in any LaCouture Hockey LLC classes or training both onsite and offsite. *

By checking here, you accept this disclaimer and do not hold LaCouture Hockey LLC liable

FMC WAIVER FORM IS REQUIRED.

FMC Waiver form will be sent to you prior to the start of the skills session

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of LaCouture Hockey.

Does this form look suspicious? Report

Forms