Adult / Team On-line Registration

League Play Hockey Leagues 2010
Adult / Team On-line Registration

** Pay on-line with your credit card now! Please note that you do not need to create a PayPal account to submit your credit card info securely.

Applicant Profile:

	**First Name:
	**Last Name:
	**Address1:
	Address2:
	**City:
	**Province:
	**Postal Code:
	**Community Centre:

	**Telephone (home):
	Telephone (work):
	Emergency / Cell:
	**Email:

Team Profile:

	**Team Name:
	**Manager’s Name:
	**Colors:
	**Division Desired:

Program Selection:

	1. Winter Hockey: $5,200.00

	2. Spring Hockey:

	3. Summer Hockey:

	4. Adult Basketball: $750.00

**Consent and Waiver of Responsibility:
The players of the aforementioned team authorize the Dakota Community Centre to take photographs and to display and otherwise use these photographs without charge solely for the purpose of promotional material in connection with the Dakota Community Centre.

The players of the aforementioned team agree that the Dakota Community Centre and its staff will not be held responsible for any accidents or loss of personal property, and agrees to release the Dakota Community Centre from all claims and/or damages which may arise as a result of such accidents or loss.

Note: The League Director reserves the right to move any team from one division to another if it is deemed necessary for better balance within the league, at any time during the schedule.

Provide other comments on special instructions here:

Please contact me as soon as possible regarding this matter.