Personal Information
Physical Address
Postal Address
Contact Details
If player under 18 years of age:
Citizenship:
Medical Information:
Player Information
Please select & mark with X and attach payment to form
INDEMNITY FORM
I, the undersigned, by my signature and completion of this document:
- Agree to abide by the Rules and Constitution of the South African Ice Hockey Association
(which adheres to the rules and Disciplinary regulations of IIHF);
- know that Ice Hockey is a contact sport which is played at speed, and know that I may be
injured whilst playing / officiating / practicing ice hockey, or whilst attending matches / camps /
events or as a spectator;
- have willingly chosen to play /officiate / practice ice hockey in the full knowledge of these
facts;
- understand and accept that the South African Ice Hockey Association and the lessees of ice
rinks will not be held responsible for any injury, accident or death howsoever arising which
occurs whilst I am playing, officiating or watching matches / practices or traveling to and from
any ice hockey game or practice.
I understand that I play / officiate / practice ice hockey entirely at my own risk.
In the event of it being found that I have any claim(s) whatsoever against any of the foregoing
persons, notwithstanding the terms of this declaration, then I hereby waive any rights of such nature
which I may have and irrevocably agree not to pursue any such claim
Player Signature
Date Signed
TO BE COMPLETED BY PARENT/GUARDIAN IF PLAYER IS UNDER 18 YEARS OF AGE
I
(full names), am the Parent or Legal Guardian of
the a forenamed player.
By my signature hereunder, I agree that I am bound by the provisions of this declaration insofar as I, in
my capacity as Parent or Guardian of the player, may personally have no claim arising in the
circumstances referred to in the paragraph above.
Sign Here using your mouse, stylus or finger
Parent / Guardian Signature
Date Signed