ashl fall / winter 2011/12 team registration - Canlan Ice Sports

ASHL FALL / WINTER 2011/12 TEAM REGISTRATION
MANDATORY FORM FOR ALL TEAM ENTRIES (PLEASE PRINT CLEARLY).
FACILITY
REGISTRATION NUMBER
(ADMINISTRATION USE ONLY)
TEAM NAME
HOME JERSEYS
AWAY JERSEYS
FIRST NAME INITIALS LAST NAME
STREET APT. #
-
CITY PROV. / STATE POSTAL / ZIP CODE
- - - -
AREA CODE DAY PHONE AREA CODE EVENING PHONE DATE OF BIRTH (DD/MM/YY)
-
AREA CODE FAX NUMBER e-MAIL ADDRESS
PREFERRED METHOD FOR RECEIVING ASHL AND CANLAN ICE SPORTS INFORMATION
e-MAIL TELEPHONE MAIL (PLEASE SELECT ALL THAT APPLY)
1st Choice
2nd Choice
PREFERRED GAME DAY / LEAGUE:
PREFERRED DIVISION: 18+ A B C D E
30+ A B C D E
Oldtimer's 40+ 45+ 50+
55+ 60+ 65+
Women's A B C D E
CoEd A/B C/D
PRIME TIME LEAGUE FRIDAY NIGHT SATURDAY DAY SUNDAY AM/PM 45
TEAM FEE $ 6870.00 TEAM FEE $ 6370.00 TEAM FEE $ 5870.00 TEAM FEE $ 6870.00
13% HST $ 893.10 13% HST $ 828.10 13% HST $ 763.10 13% HST $ 893.10
TOTAL $ 7763.10 TOTAL $ 7198.10 TOTAL $ 6633.10 TOTAL $ 7763.10
PAYMENT TERMS FOR REGISTRATION VISA MC EXPIRY DATE
TEAM DEPOSIT - $1,500.00
CREDIT CARD NUMBER (MANDATORY)
15-Oct-11
Nov 15,2011
Balance Dec 15,2011
$2,500.00
$2,500.00
-- -- --
CARDHOLDER NAME: _______________________________
TRANSACTION AMOUNT: $ ___________________________
$200.00 Admin Fee Applied: January 2nd 2012
SIGNATURE: _______________________________________

ASHL TERMS AND CONDITIONS
ALL TEAM MEMBERS / PLAYERS ACKNOWLEDGE THAT THERE WILL BE NO TOLERANCE FOR ABUSE OF
OFFICIALS IN THE ASHL. OFFENDERS WILL BE SUSPENDED ACCORDINGLY.
PART A – ASHL
The Participant assumes all risk of personal injury that may result from participation in all activities of the ADULT SAFE HOCKEY LEAGUES (a division of
Canlan Icesports Corporation). The Player will not hold the ASHL, any ASHL officials, staff, owners, or the proprietor or employees of any ice facility used by
the ASHL, liable for injury that the Participant may sustain while participating in any ASHL activity. The Participant understands and agrees that the sport of
ice hockey has physical dangers that may result in serious injury or death. The Participant is advised to carry medical insurance. The Participant certifies
that he / she has no known medical condition that would prohibit him/her from participating in the sport of ice hockey. The Participant agrees to wear
specified equipment set out in ASHL rules. The Participant agrees that he/she will act in a responsible manner in all ASHL activities. The Participant agrees
to reimburse the ASHL, in full within five days of notice, for the cost of any property damage for which the Participant is held responsible by the ASHL staff or
owners. The determination of such responsibility shall be binding on the Participant. The Participant agrees to the ASHL policy that there is no
reimbursement to any Participant.
The Participant assumes all risk of personal injury that may result from participation in all activities of the ADULT SAFE HOCKEY LEAGUES (a division of
Canlan Icesports Corporation). The Player will not hold the ASHL, any ASHL officials, staff, owners, or the proprietor or employees of any ice facility used by
the ASHL, liable for injury that the Participant may sustain while participating in any ASHL activity. The Participant understands and agrees that the sport of
ice hockey has physical dangers that may result in serious injury or death. The Participant is advised to carry medical insurance. The Participant certifies
PART B – CANLAN ICE SPORTS CORP.
Each Participant using the ice facilities of Canlan Ice Sports Corp. ("Canlan") assumes all risk of personal injury that may result from participation in any
activity conducted in any Canlan Ice Sports facility. The Participant will not hold Canlan or any of its officials, staff, owners or the proprietor or employees of
any Canlan Ice Sports facility liable for injury that the Participant may sustain while participating in any of the aforesaid activities. The Participant understands
and agrees that any sport or other activity conducted on ice has physical dangers that may result in serious injury or death. The Participant is advised to
carry both primary and extended medical insurance. The Participant certifies that he / she has no known medical condition that would prohibit him/her from
engaging in any activity on ice.
PART C – INDUSTRIAL-ALLIANCE PACIFIC LIFE INSURANCE
In conjunction with the ASHL (Canlan Ice Sports Corp.), Artel Insurance Services Inc. (the broker), and Industrial-Alliance Pacific Life Insurance Company (the
Insurer), each Participant using the ice facilities of Canlan Ice Sports Corp. ("Canlan") will receive Accidental Death and Dismemberment coverage as part of
the ADULT SAFE HOCKEY LEAGUE at no additional cost to the individual. To be eligible for insurance coverage, each Participant must complete the ASHL
Online Registration process at www.ashl.ca and provide an accurate digital signature at the time of ASHL Player Card production (or written signature
below if not playing at a facility with digital signature / Player Card technology). The information provided in this process may be used in registering each
Participant with the insurance provider. Failure to complete this process in its entirety or providing any false or misleading information or omitting any
material information will nullify the participant from insurance coverage with the ASHL and its insurance carrier or may result in denial of coverage by the
insurer.
All ASHL Players are encouraged to request and review the current Accident Coverage Policy brochure, available through the Facility and / or League
Manager.
PART D – PAYMENT TERMS AND CONDITIONS
ALL TEAM ENTRIES :
A minimum $1,500.00 deposit must accompany your registration to be guaranteed a spot. The balance will be payable according to the payment terms of the
host facility. It is the responsibility of each Participant in the ASHL to learn these payment terms by either attending Team Rep Meetings, held in advance of
the season start date, or from his/her Team Rep. All late payment amounts are subject to a 14% (fourteen percent) interest charge calculated daily at
(0.038356%). As of the FINAL PAYMENT DATE, Canlan Ice Sports Corp. reserves the right to charge all outstanding amounts including interest charges to
the credit card provided by the registrant. Post-dated cheques are not exempt from late fees. Some locations may have other late penalty fees, please
consult your facility manager for any alternative methods of late penalty fees. No refunds on deposits.
ALL INDIVIDUAL ENTRIES :
For all Individual Entries, the Participant must pay 50% (fifty percent) of the required amount upon registration and the balance due prior to the first game. No
refunds on deposits. Payments may be made by Debit Card, Visa, Master Card, Cash or Cheque. If the balance of the payment is not received on or prior to
the first game, Canlan Ice Sports Corp. reserves the right to bill all outstanding amounts to the credit card provided by the Participant.
Part E – Privacy Policy
Personal Information Protection: Canlan collects and uses personal information in line with the 10 Privacy Principles. By providing us with your information
you consent to Canlan’s use of the information in providing you with products or services and / or information about products or services. For more
information, ask for a copy of our brochure: Protecting Personal Information & Privacy Makes Good Sense or visit our website at www.icesports.com.
Part F – Acceptance of ASHL Terms and Conditions
I have read this agreement thoroughly and understand the terms. No oral representations or statements or inducements have been made to me that change,
alter, or modify anything within the written agreement.
Applicant's Signature of Acceptance to the above Terms and Conditions
Date
Canlan Ice Sports Corp. Authorization
Date