Lamoille Area Girls Hockey Association

U-14/16: for ages 13 & up   + NEW! U-12: for ages 11 and up

Nov. ’09 – Feb ‘10

            Player’s name:_______________________________   Email:_____________________

Address:______________________________________________________________

 School & Grade:_____________________________  Date of birth________________

Mother’s Name:______________________________  Phone/cell:_________________

     and/or

Father’s name:________________________________Phone/cell:__________________

Parent email:___________________________            Home phone:_________________

Skating experience (please check all that apply):

None:_________          Stop:_________

            Forward:______           Crossovers:____

            Backwards:____           Hockey Experience:_____

àà Family member(s)  please sign up now for:  equipment organizing (major need), fundraising events, games (time keeper, refreshments) or other important team jobs :

Name:_________________________________Preferred job:_____________________________

____________________________________________________________________________________

Mission Statement:  Lamoille Area Girls' Hockey Club

To provide instructional and fun ice hockey programs for girls ages 11 and up who want to improve their skating skills, learn the sport of hockey, increase strength and stamina, and have fun learning and playing as a team.  Team members and their families will work together to raise sufficient funds to make the participation fee affordable for any girl who wants to play.

For more information call:  Jane Nutting 888-3044 or Darlene Chatot 888-3250

To learn more about this and other youth hockey offerings at Green Mountain Arena,

go to  www.lamoillehockey.com

Size (give as much info as possible-for the equipment buyer.  Please circle all that apply:)

            Girls/kids:    XS     S      M       L      XL                                     Approx. Height:_________

            Mens: (for shirt size) :     XS     S      M       L       XL                Approx. Weight__________

                        (for pants size) :    XS     S      M       L       XL               Usual clothing size:__________

                                                                                                                  (Pls. State Girl or Jr./Misses)         Womens: (for shirt size):      XS     S     M      L       XL                                                            

Do you have your own equipment? _____________    or  LAGHA’s borrowed equipment?__________

IF YES : Does it still fit you? _____(Have you checked?)_____  Is there any piece you still need?___________________    

(All players will provide their own helmet, hockey skates, stick, mouth guard and neck guard)

Amount paid:     ___________      ____________     ____________

Date:                  ___________      ____________     ____________

09-10  USA Hockey membership number________________________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 (Detach here and keep bottom portion for your records)

Fees:   U-14/16:    $350  for the season  (or $325, early discount:)

                       $150 due at registration   (PAID: $_______date________check#______)  

                    + $200** due by Nov. 15    (PAID: $_______date________check#______ )

                     **(Early discount:  $175 if paid by Oct. 15)

                   Please inquire about a payment plan if needed, for you to play.

          U-12:  LOOK!    $50 for the first 6 week session!!       Introductory  fees this yr                                     then  $85 for the next 9 week session!!

                   Payable to :  Lamoille Area Girls Hockey Association

Give or mail to:   Darlene Chatot,  860 Pinewood Est., Morrisville  05661    888-3250

Plus:  ALL  PLAYERS MUST  ALSO  REGISTER ONLINE AT  www.usahockey.com        to obtain their USA Hockey membership #.  There is a $32  fee payable online.

You MUST provide your  USA  Hockey membership number to

Darlene  (fafards@myfairpoint.net)  BY OCT. 15  to start  skating  on  Nov. 2.
Lamoille Area Girls Hockey Association

Permission, Equipment return, Waiver, Consent to treat, and Insurance info

Player's name _____________________________________

The player named above has my permission to participate in the activities of the Lamoille Area Girls Hockey Association (LAGHA).  And,

I agree to return all equipment borrowed from LAGHA at the end of the 2009-10 season.  And,

I will not hold responsible:  LAGHA coaches or parent helpers, Lamoille Area Hockey Association (LAHA),  the Green Mountain Arena or its staff  or volunteers for any incidents or injuries occurring as a result of activities sponsored or directed by LAGHA.  And,

I give my permission for LAGHA or its representatives to obtain emergency medical attention for my child if I am not available for consultation at the time of injury.

___________________________________            _________________________

Parent or guardian signature                                       Date

___________________________________              _________________________

Name of insurance co.                                                Policy no. 

Please complete medical history on the medical form (available in pdf format on the medical form link at the top of the LAGHA page)