Date of Birth:

City:

Erie Lady Lions Girls’ Hockey Association

P.O. Box 8381 Erie, Pa. 16505

Phone: 814-450-7008 Fax: 413-473-1912

E-mail: erieladylions@earthlink.net www.erieladylions.com

PLAYER REGISTRATION

Name:

SS#: Phone:

Address:

State: ZIP:

Parent/Guardian:

Returning Player: Yes No New Player: Yes No

Cash __________ Check __________

(4 Tournaments & District Play down Commitment)

PARENT/GUARDIAN INFORMATION

Name: Relationship:

Name: Relationship:

Address:

City: State:

Phone: Alternate Phone:

Parent Email:

PARTICIPANT FEES

A non-refundable commitment fee $150 , the fund raising fee, and ALL applicable additional fees must be paid at registration.

ONE/HALF OF ALL TOTAL FEES ARE DUE BY SEPT. 1 AND ALL REMAINING FEES ARE DUE BY OCT. 15.

BASIC FEES: BASIC FEES:

$________ Additional Fees

$________ TOTAL DUE

Forms Verification:

ADDITIONAL FEES:

$________ Amt. paid at Registration

Jersey Purchase $120.00

Late Fee-After 9/1 $ 25.00 (Returning only) Consent To Treat: ___ Waiver: ___ Code of Conduct: ___

Equipment Rental $ 50.00

PLEASE READ AND SIGN BELOW

The Erie Lady Lions Girls’ Hockey Association, Inc. assumes no responsibility resulting or liability resulting from injuries by

its’ members while participating in any activity sponsored by the Erie Lady Lions Girls’ Hockey Association, Inc. Also, nonpayment

of any installment on the due date herein set forth shall forthwith render all remaining installments immediately due

and payable. It is also understood that failure to meet all the above terms will result in the suspension of my child/self until

such time that the arrangements are satisfied in full. In addition, restitution for damage caused by a player or family member

to facilities or property of Erie Lady Lions Girl’s Hockey Association, Inc. shall be the sole responsibility of the parent/player

or adult participant and/ or family member who caused the damage. I understand and agree to all the above terms.

Signature of Parent/Guardian:___________________________________________ Date:______________________

Fund Raising Fee $200.00 Zero Tolerance: ___ Copy of Birth Certificate: ___