Player Registration Forms

Please complete all required fields to secure your child's spot. Fields marked with an asterisk (*) are mandatory. If registering more than one child, be sure to fill out all fields for each child. The Waiver and Code of Conduct are also attached for your signature.

Parent Full Legal Name *

First & Last Name

Parent Full Legal Name (optional)

Email 1 *

Email 2 (Optional)

Phone *

Secondary Phone (Optional)

Are you interested in volunteer opportunities?

Player Information

Player Full Legal Name *

Date of Birth *

Jersey Number Request (3 Options) *

(We will do our best to accommodate.)

Jersey Size Confirmation *

(Youth or Adult size XS through XXXL)

Ice Hockey Experience? *

Will player be in Ice Hockey concurrently? *

Yes
No
Maybe

Please indicate number of years playing Hockey (inline and/or ice)? *

Please List Any Allergies *

Player 2

Player Full Legal Name

Date of Birth

Jersey Number Request (3 Options)

(We will do our best to accommodate.)

Jersey Size Confirmation

(Youth or Adult size XS through XXXL)

Ice Hockey Experience?

Will player be in Ice Hockey concurrently?

Yes
No
Maybe

Please indicate number of years playing Hockey (inline and/or ice)?

Please List Any Allergies

Player 3

Player Full Legal Name

Date of Birth

Jersey Number Request (3 Options)

(We will do our best to accommodate.)

Jersey Size Confirmation

(Youth or Adult size XS through XXXL)

Ice Hockey Experience?

Will player be in Ice Hockey concurrently?

Yes
No
Maybe

Please indicate number of years playing Hockey (inline and/or ice)?

Please List Any Allergies

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Name (Secondary)

Emergency Contact (Secondary)

If there's anything you'd like us to know about your child(ren) or any special requests, please let us know.

WAIVER AND LIABILITY

By affixing my signature to this form, I, on behalf of myself, and my heirs, assigns and next of kin, hereby enter into this Waiver Agreement IN CONSIDERATION OF my being able to participate as a volunteer at practices, games or other activities (“EVENTS”) sanctioned by the El Segundo Inline Hockey Association (“ESIHA”) and to enter the premises or facilities where the EVENTS are taking place.

DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: I ACKNOWLEDGE THAT PARTICIPATION IN HOCKEY NECESSARILY INVOLVES CONTACT WITH CONSIDERABLE FORCE, AND RISK OF SEVERE, PERMANENT PHYSICAL INJURY INCLUDING BRUISES, SCRAPES, STRAINED, SPRAINED OR TORN MUSCLES, TENDONS OR LIGAMENTS, BROKEN BONES, DISLOCATION OF JOINTS, CONCUSSION, BRAIN DAMAGE, NERVE AND SPINAL CORD INJURY, PARALYSIS AND DEATH. I WILLINGLY AND VOLUNTARILY ACCEPT AND ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES.

I HEREBY RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS, TO THE FULLEST EXTENT PERMITTED BY LAW, ESIHA, ITS PLAYERS, EMPLOYEES, VOLUNTEERS, OFFICIALS, SPONSORS AND OTHER REPRESENTATIVES AND ALL OWNERS, LESSORS, LESSEES OR OTHER PERSONS OR ENTITIES ALLOWING THE USE OF FACILITIES BY ESIHA AND THE AGENTS, EMPLOYEES, OFFICERS AND DIRECTORS OF SAID PERSONS OR ENTITIES (“RELEASEES”) FROM ALL CLAIMS, DEMANDS, CAUSES OF ACTION, COSTS, EXPENSES AND COMPENSATION ARISING OUT OF OR IN ANY WAY RELATED TO A LOSS, INJURY OR OTHER DAMAGE TO ME OR TO MEMBERS OF MY FAMILY OR MY HOUSEHOLD OR INDIVIDUALS I INVITE OR FOR WHOM I AM OTHERWISE RESPONSIBLE, OR THEIR PROPERTY, WHILE PARTICIPATING IN OR PRESENT AT ANY OF THE EVENTS, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I ACKNOWLEDGE THAT ESIHA IS PRIMARILY ADMINISTERED BY VOLUNTEERS RATHER THAN PAID PROFESSIONALS. I ACKNOWLEDGE AND AGREE THAT THIS WAIVER AGREEMENT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS PERMITTED BY THE LAWS OF THE STATE IN WHICH PARTICIPATION TAKES PLACE AND AGREE THAT IF ANY PORTION OF THIS WAIVER AGREEMENT IS DEEMED TO BE INVALID, THE REMAINDER WILL CONTINUE IN FULL LEGAL FORCE AND EFFECT. ACKNOWLEDGEMENT AND CONSENT.

For internal and external use, ESIHA may obtain, compile and use contact information, hockey photographs and audio visual recordings of me or my child. I consent to such uses and hereby waive all rights to approval and compensation.

I HAVE READ ALL AGREEMENTS SET FORTH HEREIN AND I FULLY UNDERSTAND THE TERMS OF EACH AND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS FORM AND AGREEING TO SAID TERMS. I SIGN THIS FORM FOR MYSELFAND ON BEHALF OF MEMBERS OF MY FAMILY, AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT. I ALSO AGREE TO INFORM ESIHA IN A TIMELY MANNER IF ANYTHING ON THIS FORM CHANGES.

I agree to use an electronic signature and that any physical or electronic copy of this registration form and its attachments can be used as if it was an original.

I am an adult of the age of majority in my state. I agree the terms and conditions hereof shall apply to all of my participation in the Events, regardless of the year or season in which such participation takes place, unless superseded by a new volunteer application.

Signature:___________________________________________ Date:________________

Print Name:__________________________________________

Electronic Signature (Type your full name): *

Date:

Code of Conduct

Players, parents, spectators, coaches, and all team officials will conduct themselves in a manner conducive to good sportsmanship by the following:

· Not using abusive, obscene, or threatening language or gestures of any manner.

· Not using physical violence in any manner.

· Avoiding any other behavior that would disrupt a game or practice.

Parents will also:

· Be positive, applaud the good, and don’t dwell on the bad. Don’t forget, kids imitate parents.

· Respect the coach’s and referee’s decisions.

· Stress fair and sensible play.

· Stress the importance of the team.

· Keep things in perspective; this is not the NHL.

· Realize winning is not everything.

· Don’t yell if your kid makes a mistake; point out the good to them.

· Try to take time to learn the game.

Remember, coaches and league administrators are volunteers and do their best to create fair teams and teach the players to the best of their ability.

Players will also:

· Be a good sport.

· Be on time for games and practices.

· Be a team player.

· Respect your coaches, teammates, parents, opponents, and officials.

· Never argue with an official’s decision.

If the league requests a test for COVID-19 at any time due to local circumstances or laws, you agree to comply.

This Code of Conduct applies to behavior in person at any ESIHA function, at the rink, by email, text, phone, Zoom, or any other online platform, or by social media. Failure to abide by the Rules of Conduct in person or on any of the previously listed mediums may result in expulsion from the league (without refund).

Please be aware that skating, stick handling, or puck shooting is prohibited on the west side of the rink. Due to player safety, it is no longer acceptable to warm up in this area.

Let’s all enjoy the hockey season and thank you for your continued support!

I agree to use an electronic signature and that any physical or electronic copy of this registration form, and its attachments can be used as if it was an original.

Signature:___________________________________________ Date:________________

Print Name:__________________________________________

Electronic Signature (Type your full name): *

Date:

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

If you have any questions, please email us at info@esiha.org with REGISTRATION in the subject line.

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

ESIHA Registration Flier Winter '25 Season