Member: Vianney Club Hockey
Student: Attending Vianney High School
Grade 9 10 11 12 (circle one) Address____________________________________________________________________ City__________________________________ State___________ Zip Code_____________ Phone________________________________ Birth Date___________________ Birth Place_________________________________________________________ I, the undersigned parent or legal guardian, do hereby consent and agree that the above named minor may participate in the Mid-States Club Hockey Association program, or any other sports program sponsored by his/her Club Team. It is agreed that the Association (League) or Club Team assumes no legal liability for inquires or other loss as a result of such participation. It is further agreed that his consent shall remain in full force and effect until such time as the undersigned parent or legal guardian shall notify the Association in writing or the abrogation or cancellation of this consent. I further understand that I must provide my own Medical Insurance Coverage. I further agree to abide by the Rules and Regulations of the association as enforced by the Board of Directors and Officials of the Mid-States Club Hockey Association.
To be eligible to play, a player must supply the League with a copy of his/her latest semester grade card. This includes the grade card atthe end of the Spring Semester as well as the Fall Term Grade Card. Player must earn at least 2.50 credits per semester. To be eligible to play, a player must supply the Mid-States Club Hockey Association office with a copy of his/her January to June grade card. Summer will be considered only if Ladue approves the course and the course is added to the students transcript. Please staple a copy of grade card to this form. |