CCAHA SIGN UP FORM

If you have any questions contact Jeremy Berry at 361-548-3019 or email huck9880@yahoo.com

PLEASE SIGN UP BY EITHER....

A.)  DOWNLOADING THE FORM, FILLING IT OUT, AND BRING IT TO THE ICERAYS 
       FRONT OFFICE OR FAX IT TO 361-980-0003.

B.)  FILL OUT THE ONLINE VERSION BELOW. 

2012-2013 COST: $395

Corpus ChristiAmateur Hockey Association

Player Application and Information Form

2012-2013

Please Print

Player Name: ________________________________________________________________

(Last)                                                                      (First)                                                      (Initial)

Circle One:   Male     Female                     Age _____     Date of Birth _____________________

JerseySize ________________  Preferred Number ________    Division: ________________

****CCAHA MUST HAVE A COPY OF BIRTH CERTIFICATE AND USA

HOCKEY REGISTRATION NUMBER BEFORE PLAYER IS ALLOWED ON THE ICE*****

Address: ______________________________________________________________________

City: _____________________________________________  State: _____  Zip: _____________

Home Phone: ______________ Cell Phone: _______________ Other Phone: _______________

E-mail Addresses: _______________________________________________________________

Mother’s Name: ________________________ Employer: __________ Work #: ______________

Father’s Name: _________________________ Employer: __________ Work #: ______________

Previous Ice Hockey experience?    ____ Yes    _____ No

Parents please read and sign the following statement:

The player named above has my permission to participate in the activities of the Corpus Christi Amateur Hockey Association, (hereinafter named CCAHA). I agree to pay the fees and abide by the policies established by CCAHA. I also understand that the player must be a member of USA Hockey in good standing. If I fail to do either, the player will not be allowed to participate. I release and will not hold responsible CCAHA, it’s officers, coaches, referees, other players or the Corpus Christi Ice Rays and its staff for any accidents or injuries occurring as a result of activities sponsored or directed by CCAHA. I give my permission for CCHA or its representatives to obtain emergency medical attention for my child if I am not available for consultation at the time of injury.

____________________________________________                        ______________________

Parent or Guardian Signature                                                                    Date

           BRING THIS FORM TO THE ICERAYS FRONT OFFICE OR FAX TO 361-980-0003