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Dayton Recreational Amature Hockey Association Complete one form for each player or participant (coaches, players, assistants, etc.) who will have access to the team area. Only one form per person is needed. |
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| Please Print: | ||||
| Last Name | First Name | Middle Initial | ||
| Address | City | State | Zip | |
| / / | ( ) | ( ) | ||
| Birtdate mm/dd/yy | Home Phone | Work Phone | ||
| Emergency Contact: | ( ) | |||
| Name | Phone | |||
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I, the undersigned, in consideration of playing hockey in RAHA, The Dayton Recreational Adult Hockey Association, (LICENSOR) do hereby release and waive said licensor, it’s employees, on/off-ice officials, and administrators from any and all liability associated with my participation in any activity in Dayton RAHA. This waiver and release extends to all heirs, assigns or guardians for myself or action in my behalf. I realize the inherit dangers associated with playing ice hockey. I am in good health and have no physical condition that would prevent or restrict me from any of these activities or games. I am aware that all league dues are payable before playing and the dues are also non-refundable. I also understand that I am signing up to play for the entire season and will be charged for the entire season even if I am playing only part time. I have also been informed that wearing full facial protection in the form of a mask is strongly recommended.
I additionally certify that I am age 18 or older. I, the undersigned, have read and understand the foregoing release. |
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| Signature: | ||||
| Name | Date | |||
| ***ALL PERSONS PARTICIPATING IN ANY ACTIVITY OR EVENT RUN BY “Dayton RAHA”, WILL NEED TO HAVE THIS WAIVER FORM ON FILE**** | ||||
