2021-2022 Registration List (Stratford Rotary Hockey League)

Print 2021-2022 Registration List

Please answer all questions applicable to you. However, fields on the form that are bolded and marked with a * are required fields and must be filled in. You will not be able to complete the submission unless ALL required fields are filled in.

Player Information

First name^*
Last name^*
Gender^*
MaleFemale

Date of Birth^*

Open the calendar popup.

Date format: MM / DD / YYYY

Address^*
Address 2
City^*
Postal Code^*
Primary Phone^*

Example: ###-###-#### x###
Phone Number Location^*
HomeCellWork
Primary Email^*

PLEASE NOTE: Rotary Hockey uses email to as it's primary method of communication with players. A copy of this submission will be sent to this address when complete.

Player Details / History

Where did you play hockey last year?^*

Choose from list
Other (if applicable)

Provide additional info here
What level of hockey did you play last year?^*
Which position do you prefer to play?^*
ForwardDefenceGoalie
Please check all that apply
If applicable - Do you have your own goalie equipment?
YesNo
PLEASE NOTE: Full-time goalie assignments are not guaranteed. - Even if you have your own equipment.
Please list any medical conditions that Rotary Hockey should be aware of:
Additional Comments / Special Requests

RE: Financial assistance / special circumstances

Parent / Guardian Information

Parent / Guardian 1 First Name^*

At least one parent / guardian name is required
Parent / Guardian Last Name^*
Parent / Guardian 1 Phone

Example: ###-###-#### x###
Phone Number 1 Location
HomeCellWork
Parent / Guardian 1 Email

Example: [email protected]
Parent / Guardian 2 First Name
Parent / Guardian 2 Last Name
Parent / Guardian 2 Phone

Example: ###-###-#### x###
Phone Number 2 Location
HomeCellWork
Parent / Guardian 2 Email

Example: [email protected]
Are you interested in volunteering with Rotary Hockey?
YesNo
Please consider helping out. Rotary Hockey needs volunteers at every level to make our program work. We are especially in need of coaches. No experience is required. Rotary Hockey can provide training for interested coaches.
If yes, where would you like to help?
CoachAssistant CoachConvenorBoard Member
Please select all that apply
Volunteer Name
Volunteer Email Address

Example: [email protected]
Volunteer Phone Number

Example: ###-###-####

Vaccination Policy

All players, coaches, officials, staff and volunteers are required to be fully vaccinated to participate. Players born in 2010 and later or those who have a medical issue and are not eligible for the vaccine are exempt from this requirement. You must at least have your first dose prior to our season start of October 2nd. By October 31st, you must be fully vaccinated (at least 14 days since your second valid dose) prior to October 31st.

Indicate the participant's vaccination status^*
Fully Vaccinated
First Dose Only
Alliance Hockey Exemption Granted
Attach proof of vaccination^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.
If you are fully vaccinated, we only need proof of your last shot. If you are exempt. please provide a copy of your exemption from Alliance Hockey

If you only have one dose, please provide the date you are eligible for your second dose

Open the calendar popup.

Acknowlegements / Disclaimers / Notices

PLEASE READ ALL THE FOLLOWING AND ACKNOWLEDGE EACH ITEMS BEFORE PROCEEDING.

Name of Participant^*

Please enter the name of the person for whom this form is being completed for (player, coach, etc.)
Name of Person signing this form [Parent/Guardian must sign if Participant is under 18 years of age]^*

Enter the name of the person signing this form.

PLEASE READ ALL THE FOLLOWING. YOU MUST AGREE AND ACKNOWLEDGE EACH ITEMS BEFORE PROCEEDING.

1. By registering with Rotary Hockey you agree to all rules, regulations, bylaws and constitutions. These documents can all be found on this website.

2. Rotary Hockey will not guarantee any player / team or coaching assignments.

3. Rotary Hockey shall have the authority to reassign individual players to a different division or to a team within their own division to equalize the competitiveness of teams across the league.

4. Registration forms received with incomplete or with information found to be falsified will be cancelled and not accepted by Rotary Hockey.

5. Participation in any sport or other activity brings with it a risk of injury or loss. Rotary Hockey is not responsible for any claim, loss, injury or damage to persons or property suffered during activities both on and off the ice.

6. ARENA ZERO TOLERANCE POLICY - The City of Stratford and the Minor Sports Council Members: Physical or verbal abuse directed towards officials, convenors, coaching staff, arena staff, players or spectactors before, during or after a sports function will not be tolerated. Offending person(s) may be asked to vacate the sports venue(s). A further banning may result pending review by participating sports group(s).

I have read and agree to all of the 6 items above.^*
ROWAN'S LAW

As of July 1st, 2019 the Ontario government implemented Rowan’s Law; in memory of Rowan Stringer who sadly died as a result of multiple concussions. This concussion awareness program requires all participants of Stratford Rotary Hockey to read the Education Materials and once completed acknowledge that they have done so.

All participants who are under 18 years of age must have a parent or guardian do this on their behalf. Participants include not just players, but also coaches, assistant coaches and trainers. If you have multiple children in the league, a separate acknowledgement must be completed for each child.

Please read the applicable Rowans Law documents below (based on the age of the participant). All players/parents/guardians/coaches/trainers must review the material and acknowledge that they have done so below.

- Players Aged 10 and Under
- Player Aged 11 to 14 years
- Player Aged 15 and Up

To view the complete acknowledgement - click here: - Appendix A

I acknowledge that I have reviewed the OHF Concussion Code of Conduct (Appendix A) and the appropriate Concussion Awareness Resources and commit to operating within the parameters of the OHF Concussion Code of Conduct under the role which I have registered with the OHF.^*
City of Stratford COVID-19 Waiver

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN RIGHTS, INCLUDING THE RIGHT TO BRING A LEGAL CLAIM AGAINST THE CITY.

PLEASE READ CAREFULLY!

IN CONSIDERATION OF THE CORPORATION OF THE CITY OF STRATFORD GRANTING ME PERMISSION TO ENTER THE ROTARY COMPLEX, ALLMAN ARENA OR DUFFERIN ARENA, I HEREBY AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

ACKNOWLEDGEMENT AND ASSUMPTION OF RISK

I AM AWARE THAT THERE IS A RISK OF ILLNESS INVOLVED IN MY USE OF THE ARENAS. Due to the ongoing COVID-19 pandemic, there is a risk of contracting COVID-19 through use of or attendance at the arenas for associated activities.

Adherence to all applicable City policies and procedures, and to any and all directions given by City staff regarding COVID-19 mitigation measures, may mitigate but does not eliminate this risk.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY

In consideration of being allowed to voluntarily attend the arenas for associated activities, on behalf of myself, my personal representatives, heirs, next of kin, successors and assigns, I hereby:
1. Waive any and all claims, demands, actions, and causes of action of any kind or nature whatsoever in law, in equity or otherwise that I have or may in the future have against the Corporation of the City of Stratford, its members of council, officers, directors, employees, agents, and representatives (all of whom are hereinafter collectively referred to as the “City”) which arise as a direct or indirect result of my or my family’s participation in attendance at the arenas;
2. Release and Discharge the City from any and all liabilities for any loss, damage, injury or expense I or my child may suffer, or that my or my child’s next of kin may suffer as a result of my or my family’s attendance at the arenas, due to any cause whatsoever, including negligence, breach of contract, or breach of the statutory or other duty of care. I acknowledge my responsibility to ensure adequate medical, personal health, dental and accidental insurance coverage, as well as protection of my or my family’s personal property.
3. Agree to hold Harmless and Indemnify the City from any and all liability for any damage to property of, or personal injury to, any person, resulting from my or my family’s attendance at the arenas.
AGREEMENT

I agree to adhere to all policies, procedures and directions given by the City relating to my or my family’s attendance at the arenas.

In entering into this Agreement, I am not relying upon any oral or written representations or statements by the City other than what is set forth in this Agreement.

This Agreement shall be Effective and Binding upon my heirs, next of kin, executors, administrators, assigns, and representatives in the event of my death or incapacity.

This agreement shall be construed broadly to provide a release, indemnification and waiver to the maximum extent permissible under applicable law.

In signing this form, I hereby acknowledge and represent that I have fully read this Agreement, I understand it and agree to it voluntarily, and that I am 18 years of age or older and of sound mind.

I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT CHECKING THE BOX BELOW SHALL HAVE THE SAME EFFECT AS AFFIXING MY SIGNATURE TO THIS AGREEMENT, AND THAT BY DOING SO I AM GIVING UP LEGAL RIGHTS AND/OR REMEDIES WHICH MAY OTHERWISE BE AVAILABLE TO ME OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND/OR ASSIGNS REGARDING ANY LOSSES I MAY SUSTAIN AS A RESULT OF MY ATTENDANCE AT THE ARENAS.

READ ENTIRE AGREEMENT BEFORE SIGNING

IF SIGNING FOR A PERSON UNDER THE AGE OF 18:

I am the lawful guardian of the child listed as the participant on this form. As the lawful guardian of the participant named above, I understand that by checking the box below, I am agreeing on behalf of the participant to be bound by this Agreement.
I agree to the terms and conditions stated above^*
GENDER IDENTITY & DIVERSITY PROGRAM

Stratford Rotary Hockey is a fully inclusive organization and adheres to the guidelines and principles as set out by Hockey Canada (HC) and the Ontario Hockey Federation (OHF). As a member of HC and the OHF, we are required to provide each player with the opportunity to obtain Gender Diversity & Expression training. This training would be based on the OHF online course “Understanding Discrimination based on Gender Identity and Gender Expression Training”.

Topics covered in this online training program will include:
Gender Definitions
Gender Pronouns - including pronouns for trans or gender diverse people who may be on your team
Players’ Rights/Responsibilities as per the HC/OHF Anti-Discrimination Policies Pertaining to Gender Identity/Gender Expression
Accommodations for Players Who May Face Barriers
Respecting the Confidentiality of Those on Your Team

THIS IS NOT A MANDATORY REQUIREMENT. IT IS ENTIRELY OPTIONAL. If you choose to not have your child to attend the training, you must declare that you wish to opt out of the program here on this form.
Please Choose on Option^*
I wish to OPT-OUT of the Gender Identity & Diversity Training for the player I am registering
YES - I wish to have the player I am registering participate in the Gender Identity & Diversity training (by choosing this option, the player will be required to complete on online course on their own time prior to taking part in any hockey activities)

Fees

Stratford Rotary Hockey is planning to run a standard program for the 2021-2022 season. Full 5 on 5 game play with all standard hockey rules & regulations. There is no body contact at any level of Rotary Hockey. Out of Town Fee for the 2021-22 season is $75.00 per player for the first 2 players only. Families with 3 or more players pay the fee for the first 2 players only.

Hockey Fees^*
Out of Town Fees^*

If claiming exemption for City owned property, please fill in field below
Out of Town Exemption Address

This field is only necessary if you are claiming the exemption above.

Payment

Please select the payment option you wish to use to pay for your registration.

Method of Payment^*
PayPal or Credit Card
eTransfer - please send eTransfer to [email protected]
Other - please contact me
Please choose one item

PAYMENT OPTIONS:
Regardless of which method of payment you choose, you must submit this form to register with Stratford Rotary Hockey. After clicking the Submit Form button below, you will receive a copy of this form to the email address provided above and a submission confirmation page will display.

PayPal or Credit Card - From the submission confirmation page, you can click to pay online and you will be re-directed to our secure PayPal payment page. Follow the instructions on this screen to complete your payment.

If you are unable to pay by credit card, then we alternatively will accept an eTransfer (email money transfer). Please send the eTransfer payment to "[email protected]" and include your child's name and birth year.

We are no longer accepting cash.

If you have missed any required fields, you will be taken to the field with missing information.