Chicago Jr Blackhawks Brick Hockey Club Evaluation
OFFICIAL PLAYER PROFILE FORM

Evaluation Fee:  $100 for 3 ice sessions and include jerseys.

 
Program:   
  
 
Last Name: First MI
Address
City State Zip
Date of Birth (enter with slashes mm/dd/yyyy)
Cell Phone E-Mail
 
Parent / Guardian First Name(s) Last
Parent Cell Phone Parent E-Mail
Parent Cell Phone Parent E-Mail
 
Current Team Current Coach

Strength as a Hockey Player
 

LIABILITY AND ASSUMPTION OF RISK AGREEMENT

CLICK TO OPEN: Waiver  (YOU MUST READ)

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above,  EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES,  to the fullest extent permitted by law.

Parent / Guardian Signiture Date: