2013 Skate at the Lake SLT Tournament
Registration Form/Waiver

Pacific Hockey Association
c/o Russ Hughes
2420 Sand Creek Road #301
Brentwood, Ca. 94513
Phone: 925-305-0987 Fax: 925-634-7429 email: pha@playpha.com

Name: ___________________________________________________

Address: _________________________________________________

City: __________________ State: ______ Zip: _________________

Phone: _______________ Email: _________________

Team Name: _______________________________________

Jersey Number: ___________________ Position___________

Tournament Cost is $109 per player. Make all checks payable to: PHA

Amount Enclosed: $__________________ Payment by (circle one) Cash Check Credit Card

For Credit Card payment , please Circle the following: Visa - Master Card

Name as it appears on the card: _____________________________________ Exp. Date: __________
(Please Print Clearly)

Card Number:

















 
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, the City of South Lake Tahoe and Tahoe Sports Enterprises 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 and/or Tahoe Sports Enterprises 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: _______________________________________________ Date: ________