Ice Clams Registration 2025

Player Name *
Date of Birth *DOB of player.
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Emergency Phone *
Parent Contact Email *
Player Email If you would like email sent to parent AND player.
Mother's Name
Father's Name
Release of Liability Release of Liability/ Release of Risk: I/ We recognize and acknowledge the fact that ice hockey is a sport in which there are risks of injury to the participant. Desiring that the undersigned minor participant in the Ice Clams Hockey Program as a student and in consideration of their enrollment, I/ We voluntarily recognize , accept and assume the risk to release Ice Clams Hockey, its affiliates , officials, employees, instructors and coaches from any and all liability. We authorize the staff to take action should a medical emergency arise.
Insurance Company Name *
Policy Number *
Player Number First Choice
Player Number Second Choice
Player Number Third Choice
Signature By clicking submit you are registering for Ice Clams Hockey and you also release Ice Clams Hockey, its affiliates , officials, employees, instructors and coaches from any and all liability.