2023/24 Street Hockey League

Player Information

Childs Name*

First Last

Childs DOB*

Age*

School attending:*

What grade is your child in?*

Which league are you registering for:*

Co-ed (boys and girls)
Girls only

Parent/Guardian Information

Parent Name*

First Last

Phone*

Email*

Enter Email Confirm Email

Are you interested in being a volunteer coach this season?*

Yes
No

Name of parent who would like to coach:

First Last

Do you have a preference on who you would like to coach with:*

NO MORE THAN 2 PARENTS PLEASE

Do you observe a holiday and therefore your child cannot play before sundown on Saturdays?*

Yes
No

Comments

Authorizations

I hereby authorize Sports Universe and Kushner Academy to act for me accordingly to there best judgement in case of an emergency, which might require immediate medical attention. I also release and discharge Sports Universe and Kushner Academy, staff and all affiliations from and against any and all liabilities or causes arising out of my childs participation in the program.*

Yes
No

Electronic Signature Agreement*

By selecting the "I Accept" button below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.

I accept
I do not accept

Parent Signature*

Please type your legal name below.

You will be redirected to the next page for payment, please enter your child's name in the fields you see. The cost is $230 per child. If you have multiple children playing, please repeat these steps for each child participating.