2010 South Lake Tahoe Invitational
P.O. Box 1433 Alameda, CA 94501
Fax: 925-634-7429 1-800-PLAY-PHA e-mail: pha@playpha.com
Name: ___________________________________________________
Address: _________________________________________________
City: __________________ State: ______ Zip: _________________
Home Phone: _______________ Work Phone: _________________ Email: _________________
Team Name: _______________________________________
Jersey Number: ___________________
Please indicate the method of payment enclosed with application: Check ____ Credit Card____
Visa ___ MasterCard ___ Amount to Charge: $__________________
Name as it appears on the card: _____________________________________ Exp. Date: __________
Card Number:
For credit card payments:
Please fill out the Registration Form and send it to your team captain, or to us via:
Fax: 925-634-7429 Voice Mail: 1-800-PLAY-PHA Email:pha@playpha.com U.S. Mail: below
For payment by check:
Please fill out the Registration Form and send it, along with your check made payable to the Pacific Hockey Association or PHA, to your team captain, or to:
Pacific Hockey Association
c/o Russ Hughes
2420 Sand Creek Road #301
Brentwood, Ca. 94513
PACIFIC HOCKEY ASSOCIATION TOURNAMENT WAIVER AND RELEASE OF LIABILITY AND MEDICAL AUTHORIZATION
-PLEASE READ CAREFULLY -
1. I understand the dangers and risks of playing hockey. I agree to hold harmless the
tournament promoter (Pacific Hockey Association), their sponsors, the South Lake
Tahoe Ice Arena and the City of South Lake Tahoe in the event of an injury.
2. I agree that I will act in a mature and responsible manner at all times during the
tournament both inside and outside the arena.
3. I agree to reimburse the Pacific Hockey Association and/or the South Lake Tahoe
Ice Arena for any damages they may deem responsible as a result of my actions.
4. I understand that I am to wear and approved hockey helmet at all times that I am
on the ice. player’s bench, or penalty bench. This includes pre-game warm-ups,
breaks in the game, between periods and post game handshakes.
5. I understand that tournament organizers highly recommend that all players wear a
HECC approved face mask & mouth piece. If I choose to play without a face mask,
I understand the dangers and risk to my face, mouth, teeth and eyes. By playing
without a facemask, I understand I am risking possible blindness.
6. I have read the cancellation and refund policy shown below and agree to accept
them. I understand that should I be suspended from the tournament for any
violations of the rules, I will not be entitled to a refund.
7. I understand that I may be required to show identification before the start of the
tournament and during any game during the tournament. I understand that if I
do not present identification (a valid state Driver’s License or Identification Card),
that I will not be allowed to participate in the tournament, nor will I be entitled
to any refund.
8. I agree to abide by all the rules and regulations of the tournament as provided to
me by my team captain and posted in the Ice Arena lobby.
Signature: _______________________________________________ Dated: ________