Presented by Florida Hockey Academy

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

When:

Youth Practice:

Tuesdays, Beginner 5:00PM - 6:00PM

Youth Practice:

Thursdays, Open 5:00PM - 6:30PM

Youth Games:

Sundays 5:00PM - 6:00PM

Adult Open Hockey:

8:30 - 10:PM Check Schedule

Adult Games:

Tuesdays 8:30PM - 10:30PM

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 include 10 league games and practice/open hockey. League Fees are $100.00 for Youth and $100.00 for Adult. Yearly Registration Fee of $30.00. Yearly Jersey Fee of $30.00. Copy of Birth Certificate is 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 Required

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)

$100.00 League Fee $30.00 Yearly League Fee $30.00 Yearly Jersey Fee

Youth: (15 & Under)

$100.00 League Fee $30.00 Yearly League Fee $30.00 Yearly Jersey Fee

Comment:

Complete Registration and Mail Complete Payment to: Skate Station (Mandarin) 3461 Kori Rd. Mandarin, Florida 32257

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.

Visit the Jacksonville Jokers website: http://www.jaxjokers.com/