Valley Hockey League

Player Information

Payment Information


Division:*
Position:*
Age Level:*
Date of Birth:*
Preferred Location:*
Street:*
Apt:
City:*
State:*
Zip Code:*
Phone (Evening):*	() –
Phone (Daytime):*	() –
Cell Phone:	() –
Email:*


Amount to be Charged:
Credit Card Type: *
Name on Card: *
Billing Address same as Player's Address
Billing Street:*
Billing Apt:
Billing City:*
Billing State:*
Billing Zip Code:*
Card Number: *	Enter numbers only, no spaces or dashes
Expiry Date *

Waiver
I/we understand that accident, health and personal insurance are not provided. I/we verify the above information to be true and give our child permission to participate in the Valley Spring League. I/we the parents/guardians of the above named registrant in the Valley Spring League, hereby give permission for the registrant to participate in any and all activities during the 2019-20 season. I/we hereby waive, release, absolve, indemnify and agree to hold blameless the Valley Spring League, its organizers, sponsors, supervisors, participants and persons transporting my/our registrant to and from activities and any claims arising from an injury to my/our registrant. I/we assume all risks and hazards incidental to such activities and participation. I/we will furnish a birth certificate upon request of the League. I further give permission for the above applicant's name to be posted on the Valley Hockey League website at www.valleyhockeyleague.com.

I Accept

Please enter the Security Code:*