2021 Fall Practice Registration - Prior Lake High School Girls Hockey

In order to participate in Fall Practices, you must complete the online registration and waiver acceptance form with an electronic signature.

The cost is $325 per skater and $120 per goalie.

Hockey Player's Name*
First Last
Player's Date of Birth*
MM slash DD slash YYYY
Grade*
Player Cell Phone*
Primary Address*
Street Address Address Line 2 City State ZIP Code
Parent 1 - Name*
First Last
Parent 1 Cell Phone*
Parent 1 Email*
Parent 2 Name*
First Last
Parent 2 Cell Phone*
Parent 2 Email*
In the interest of team building, rules for no checking and no fighting will be strictly enforced. In the event of fighting, players will be excluded from other Fall Practices and NO refund will be given – no exceptions!

Rules for Fall Practice include no fighting, no checking, no slashing and no hooking. Full equipment including face mask and mouth guards will be required.
Please check box to acknowledge rules*
- I have read, understand, and acknowledge the rules for the PLHS Girl's Hockey Fall Practice – 2020.
Parent/Guardian Signature*
Player Signature*
Medical/Liability/Acknowledgement of Risk, Waiver and Release of Liability Form
NOTE: This is a Waiver and Release of Liability – Please read before signing
I/we, the parent(s)/guardian of:*
First Last
We give permission for the above-named participant to participate in the PLHS Girls Hockey Blue Line Club 2020 Fall Practice. I/We recognize that the game of hockey is a contact sport and involves the risk of injury. I/We also understand that it is my/our responsibility to outfit my/our daughter with the proper and adequate protective equipment. I/We verify that my/our daughter is physically fit to participate in all of the activities pertaining to this sport. My/Our daughter's participation in these activities is purely voluntary and no one is forcing her to participate. I/We agree to assume responsibility for all risks and hazards related and incidental to participation, including, but not limited to, games, organized practices, scrimmages, and transportation to and from the facility related to the 2020 Fall Practices.
*
- I have read, understand and agree to these terms.
I/We waive, release, and agree to hold harmless and indemnify any and all coaches and organizers of the 2020 Fall Practice, and PLHS Girls Hockey Blue Line Club members, for any claim for any reason including negligence, arising from any personal injury, damage to property, and/or wrongful death.
*
- I have read, understand and agree to these terms.
I/We, authorize the PLHS Girls Hockey Blue Line Club member volunteers, their coaching staff, organizational staff, together with medical, hospital, or emergency personnel to carry out and/or administer all treatment and diagnosis determined to be necessary. This shall include rendering of emergency care in situations where it is impractical or impossible to obtain additional consent. I/We either have appropriate insurance or, in its absence, agree to pay all costs of emergency and/or medical services as may be incurred on my/our behalf.
*
- I have read, understand and agree to these terms.
The authority hereby given shall remain in effect unless it is withdrawn in writing.
Medical Information
Emergency Contact #1*
First Last
Phone*
Emergency Contact #2*
First Last
Phone*
Physician's Name*
First Last
Phone*
Medical Insurance*
Hospital of Choice*
Allergies (if any)
Medical Problems (if any)
Parent/Guardian Signature*
Date*
MM slash DD slash YYYY
Skater or Goalie Cost*
- Skater $325
- Goalie $120

Medical Information