East Petersburg Inline Hockey - (East Petersburg, PA)

Youth League Fall 2025 - REGISTER HERE! - Due August 30th!

Registration ends August 30TH at 6:00 PM. The season begins on September 5th

Invoices will be sent to the email you signed up with. Please ensure it is correct. Please give us two business days to send the invoice. They are manually done.

PLAYER INFORMATION

* First Name:

* Last Name:

* Birthdate:

* Desired Position::

JERSEY INFORMATION

The registration Fee with a jersey is $75

The registration Fee without a jersey is $55

* Are you in need of a jersey?:

* If you are in need of a jersey, please select a size::

Jersey Number Preference::

LEVEL OF EXPERIENCE

* Roller Hockey::

* Street Hockey::

* Ice Hockey::

* Goalie::

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* Email:

* Cell Phone:

* Address:

* City:

* State:

* Zip Code:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

RELEASE INFORMATION

By selecting this box, you are agreeing that you are the parent or guardian of the participant and are over the age of 18. *

WAIVER INFORMATION

INDIVIDUAL WAIVER AND RELEASE OF LIABILITY

THIS DOCUMENT IS IMPORTANT, SHOULD BE READ IN ITS ENTIRETY AND SIGNED.

In consideration of being allowed to participate in any way in the EAST PETERSBURG INLINE HOCKEY, the undersigned:

1. Agrees that prior to participating, he/she will inspect the facilities and equipment to be used, and if he/she believes anything is unsafe, will refuse to participate.

2. Acknowledges and fully understands that he/she will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from his/her own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used.

3. Assumes all the foregoing risks and accepts personal responsibility for the damages following such an injury, permanent disability or death.

4. Releases, waives, discharges and covenants not to sue the EAST PETERSBURG INLINE HOCKEY, affiliated clubs, respective administrators, directors, agents, coaches and other employees of the organizations, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as ?releasees?, from the demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

5. Understands the following refund policy: There will be NO refunds of entry fees because of inclement weather or other acts of nature. The only exceptions to the no-refund policy are: Entries received after the entry deadline; Entries of non-qualified entrants; Entries of those prohibited from participating due to errors made by the East Petersburg Inline Hockey; Special circumstances as determined on an individual basis by the Board of Directors and requiring board action. NO REFUNDS WILL BE PERMITTED SIMPLY BECAUSE AN ATHLETE FAILS TO PARTICIPATE.

6. Agrees to allow East Petersburg Inline Hockey to photograph him/her during league games and to display his/her image in East Petersburg Inline Hockey promotions, including social media sites such as Facebook, Twitter, YouTube, Instagram, etc.

7. Pledges to adhere to the East Petersburg Inline Hockey standards of sportsmanship and respect opponents, coaches, officials and spectators at all times by not engaging in verbal or physical altercations at any time before, during or after competition.

8. Acknowledges that he/she is aware of the Concussion Awareness Law (LB 260) and understands that information is available at www.cdc.gov.

9. Acknowledges and fully understands that he/she will be engaging in activities that involve risk of serious illness, including permanent disability and death, and severe social and economic losses which might result not only from his/her own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used.

10. In the event of a season being canceled after starting, refunds will be issued at a prorated rate for the remaining, unplayed scheduled regular-season games. The rate is subject to change.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. THIS FORM WAIVES LIABILITY FOR NEGLIGENCE. THIS AGREEMENT CANNOT BE MODIFIED ORALLY.

East Petersburg Inline Hockey - www.EPIH.org

I/we agree with the above *

PAYMENT

An invoice will be sent to the email address that you registered above. This will come from Paypal, a service we use for online payments. Please pay before your season starts. If you have any questions about the invoice, please email eastpetehockey@gmail.com.

I acknowledge the invoice for payment. *

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