Southern Wisconsin Inline Roller Hockey League Team Registration Form 

Winter 2012 (Jan 9th - Mar. 19th) – Spring 2012 (Apr. 2nd - June 26th)

Summer 2011 (July 9th - Sept 24th) – Fall 2011 (Oct 8th -Dec 17th) 

10U- For skaters age 10 and under who have taken an instructional league class or have prior hockey experience. Volunteer coaches, one referee and a 10 week schedule. Weekly one hour practices available. Games played with a roller ball. Games played Sunday 4:30-7:00PM Games Played Sunday 4:30-9:30PM Games played Sunday 4:30-10:30PM Games played Tuesday or Thursday 6:30-11:00PM Games played Monday, Sunday or Wednesday 6:30-11:00PM Games played Monday, Sunday or Wednesday 6:30-11:00PM

12U- For skaters age 12 and under who have taken an instructional league class or have prior hockey experience. Volunteer coaches, one referee and a 10 week schedule. Weekly one hour practices available. Games played with an IDS pro shot puck.

14U- For skaters age 14 and under. Volunteer coaches, 2 referees and a 10 week schedule. Weekly one hour practices available. Games played with a, IDS pro shot puck.

High School- For players currently enrolled in high school that offers a high level of competition. 2 certified referees, volunteer coaches and a 10 week schedule. Weekly one hour practices available. Games played with an IDS pro shot puck.

Adult Bronze- For adult players who prefer a non-competitive environment, while playing in a structured game and getting proper physical activity. Each team will consist of NO MORE then 2 silver caliber players. 2 referees provided and open hockey offered for practice time. Games played with an IDS pro shot puck.

Adult Silver- For adult players who prefer to play in a highly competitive environment, reserved for highly skilled players. 2 referees provided and open hockey offered for practice time. Games played with an IDS pro shot puck.

Team Name: ___________________________________ Jersey Color: __________________________________

Coaches/Captains Name: _________________________________________________________________________

Address: _____________________________________________ City: _______________________ Zip: ______________

Home Phone: ____________________ Cell Phone: ____________________ Work Phone: ____________________

Email: ____________________________________________________________________________________________

Choose your session-(circle one) Winter Spring Summer Fall

Prices are based on all games being played at Fast Forward Skate Center

TEAM RELEASE FORM

PARTICIPATION AGREEMENT, PLAYER RELEASE AND ACKNOWLEDGMENT OF RISK

In consideration of the services of the Southern Wisconsin Inline Roller Hockey League, it’s agents, officers, employees, and all other persons or entities acting in any capacity on its behalf (hereinafter referred to as "SWIRHL"), I hereby agree to release and discharge SWIRHL, on behalf of myself, my heirs, assigns, personal representatives and estate as follows:

1. I agree to follow the rules, as set forth by SWIRHL, and obey the rink referee and/or supervisor at all times. An official rule book has been provided to me and I agree to fully read it, understand it and abide by it.

2. I understand the importance of using the protective equipment specified in the SWIRHL rules and agree to the use of Helmets, Gloves, Shin guards, elbow pads, Inline skates and stick specifically designed for hockey. I also understand that a full face mask and mouth guard are required for players under the age of 18 and strongly recommended for adults

3. I understand that there are inherent and other risks involved in the sport of roller hockey. Injuries are a common and ordinary occurrence in this sport and I freely assume the risks.

4. I agree that I will not play roller hockey under the influence of drugs and alcohol

5. I expressively agree and promise to accept and assume all of the risks in this activity. My participation is strictly voluntary and no one if forcing me to participate and I elect to participate in spite of all risks.

6. I hereby voluntarily release, forever discharge and agree to hold SWIRHL harmless based on my prior knowledge of all risks assumed while voluntarily participating in the sport of roller hockey. By signing this form in acknowledge that if anyone is hurt or property damaged during my participation in these activities, I will have no right to make a claim of file a lawsuit against SWIRHL, its agents, owners, employees or any other persons or entity acting in any capacity oh its behalf, even if they or any of them negligently caused such injury of damage

1. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

2. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

3. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

4. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

5. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

6. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

7. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

8. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

9. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

10. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

11. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________

12. Player Name: ___________________________________ Age: _________ Date of Birth: _____/_____/_____

Address: _________________________________________ City: _______________________ Zip: ___________

Phone: ____________________ Email: _______________________________________

Parent/Guardian Name (under 18): _________________________________________________Parent Phone: ________________