Chai Lifeline Canada: Hockey Tournament 2008

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Last Name:
Birth Date:
Gender:	Male Female
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Emergency Contact Name:
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Team:
T-shirt Size:	Youth Medium (10-12) Small Medium Large X-Large XX -Large

Credit Card Information:
Name on Card:
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I agree to take responsibility to raise $333.00 ($5000 divided by 15 players) and if I do not raise that amount I consent and agree to let Chai Lifeline Canada charge my credit card for the difference.
Waiver and Release By clicking below, I hereby acknowledge that ice skating, and engaging in the sport of hockey are strenuous activities beyond the capability of some people, and may cause minor, severe and/or permanent injuries or death to people who are not in sufficient physical fitness, training and/or experience. I also acknowledge that by participating in the hockey tournament there are inherent risks associated with the game of hockey. I have made my own determination as to whether I am able to safely participate in the hockey tournament and understand the risks associated with participating in a hockey game. I recognize that Chai Lifeline (Canada) Inc. has not evaluated my ability to participate in the hockey tournament. I also recognize that advice dispensed through Chai Lifeline Canada may not be appropriate for me, and it is my responsibility to make this determination. I acknowledge that a hockey tournament maybe or is a test of a person’s physical and mental limits and carries with it, regardless of physical fitness or experience, the potential for death, serious injury and property loss. I assume the risks of participating in the tournament. I certify that my level of fitness is appropriate to participate in the hockey tournament which I am voluntarily undertaking. I certify that I have sufficiently trained or prepared for this tournament I am undertaking and I have not been advised against participation in such activity by a health care professional. I, for myself, my past, present and future agents, attorneys, representatives, predecessors, successors, assigns, heirs and executors, do waive, release and discharge Chai Lifeline (Canada) Inc., its past, present and future officers, directors, agents, employees, volunteers (including any individual giving a presentation, advice or information in conjunction with playing hockey), attorneys, any Chai Lifeline Canada members or event participants other than myself, parents, subsidiaries, predecessors, successors, affiliates, assigns, sponsors, and representatives from any and all manner of liability, claims for damages, causes of action, proceedings, compensation, attorneys’ fees, costs and expenses of suits, claims and demands whatsoever, which may arise in the future from my participation in the hockey tournament through or involving Chai Lifeline (Canada) Inc., including, but not limited to, any and all claims, losses or liabilities for death, injury, disability, property damage, medical bills, theft or damage of any kind, including economic losses, which may in the future arise out of or relate to my participation in or traveling to and from the tournament through or involving Chai Lifeline Canada. I acknowledge that there may be mode of transportation, persons, roughing, hazards, body checking or fights present during the tournament through or involving Chai Lifeline (Canada) Inc., and assume the risk related thereto of participating in the hockey tournament through or involving Chai Lifeline Canada. I assume all other risks associated with participating in the hockey tournament through or involving Chai Lifeline Canada , including contact or effects of other participants and effects of weather. I AGREE NOT TO SUE any of the Chai Lifeline (Canada) Inc. Parties for any and all claims made or liabilities assessed against them as discharged herein. I INDEMNIFY AND HOLD HARMLESS the Chai Lifeline (Canada) Inc. Parties from any and all claims made or liabilities assessed against them as a result of (i) my actions, inactions or negligence, (ii) the actions, inactions or negligence of the Chai Lifeline (Canada) Inc. Parties and others hereby indemnified, (iii) the conditions of the facilities, equipment or areas where the tournament is being conducted and (iv) any other harm, injury or damage caused by an occurrence related to or during the tournament through or involving Chai Lifeline (Canada) Inc. I GRANT PERMISSION for the use of my name and/or likeness relating to my participation in tournament of the Chai Lifeline Canada and I WAIVE all rights to any future compensation to which I may be entitled as a result of the use of my name or likeness. IF REGISTERING A MINOR, I represent that I am the custodial parent or legal guardian of the minor. I consent to the terms of the foregoing application form, including the waiver and release of claims, on his/her behalf. I affirm I have the authority to grant such consent. I AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENTS. I understand and agree to the waiver and release