Presented by Florida Hockey Academy

Who:	Youth (Ages 15 and Under) Adult (Ages 15 and Up)

When:

Youth Practice:

Mondays 5:00PM - 6:00PM

Youth Games:

Tuesdays 5:30PM - 6:30PM

Adult Open Hockey:

Mondays 7:00pm - 9:00pm

Adult Games:

Tuesdays 7:30PM - 8:30PM and 9:30pm

What:

A non-contact game with 4 players plus goalie and up to 5 substitutes on each team. To ensure equal team strength, teams will be broken down by age groups. A chance to learn and practice the skills os one of the world's favorite games using light-weight and safe equipment.

How Much:

League Fees are $100.00 which includes 10 league games, play-offs, and practice/open hockey. A one-time yearly registration fee of $25.00 is required at the beginning of the session. There is also a one-time jersey fee of $30.00. Jersey fees are only required once as long as the jersey fits. Copy of birth certificate is also required.

Equipment:

• Roller Skates or Roller Blades • HECC Approved Helmet with Face Mask • Hockey Mouth Piece • Hockey Stick • Athletic Cup • Hockey Shin Pads • Protective Gloves • Elbow Pads • Girdles are Highly Recommended

Roller Hockey Registration Form:

Name:

Birth Date:

Parent Name:

Mailing Address:

City:

Sate:

Zip:

Home Phone:

Work Phone:

Email Address:

Emergency Contact:

Emergency Phone:

Jersey Size:

Adult: (15 & Up)

$110.00 League Fee $25.00 Yearly League Fee $30.00 Yearly Jersey Fee

Youth: (15 & Under)

$110.00 League Fee $25.00 Yearly League Fee $30.00 Yearly Jersey Fee

Comment:

Complete Registration and Mail Complete Payment to: Skate Station Funworks 1311 N.W. 76th Blvd. Gainesville, Florida 32606

Statement By Player:
In consideration for my application being accepted. I, intending to be legally bound, do hereby for myself, my heirs, executors and administrators, waive release and forever discharge and and all rights and claims for damages which I may have or which me hereafter accrue to me, against Florida entersport Inc., Skate Station or Mandarin Inc., Skate Station Youth/Adult gainesville or Mandarin Roller Hockey Leagues/Clubs to which I belong, the owner of the site where the club practices or the competitive games take place or its or their officers, agents, representatives, successors, and/or assigns, for any and all damages which may be sustained by and suffered by me in connection with any association with or entry in and for arising out of my traveling to, participating in, and returning from said Leagues/Clubs activities or practice sessions in preparation therefore. I certify that to the best of my knowledge and belief, I am in good physical condition and have no disease or injury that will be aggrieved or cause harm to me or others as a result of my participation or would impair my doing my best in my competition.

Must Agree Before Submitting Registration Form

NOTE: All registrations must be accompanied by payment. Parents will need to sign an accident release of liability form before child begins league or practice sessions.

For more information about Roller Hockey, please visit www.FloridaHockeyAcademy.com or email jason@floridahockeyacademy.com