REGISTRATION - Co-Ed Summer Hockey League 2023  Individual Entry Form

Please complete this form and then print it out in landscape format on letter paper. You can then either fax it to us on 416-392-1061 or send it to us at 140 Sherbourne Street, Toronto, M5A 2R6 or even call in and drop it off at our office.

Name		I agree to be placed on a team that in the opinion of the league directors best suits my ability and agree to pay the fee which includes 12 games plus 1 playoff game. The fee also includes a team jersey for individual teams only. I agree that Moss Park Adult Summer League and Moss Park Arena will not be held responsible for any accidents or losses however caused and agree to release the proprietors from all claims and damages which may arise as a result of such accidents or losses. The Moss Park Adult Summer League and Moss Park Arena does not provide Medical Insurance coverage you should have you own. No refunds without a medical certificate. $30 administration fee less games will apply.   ---------------------- Signature
Address
City
Postcode
Tel. (Home)
Tel. (Work)
Program
Ability	Never Played Beginner Intermediate Expert
Position	Goal Defence Winger Center
Fee	$490 before April 3/23 $590 after April 3/23
Amount Paid
Payment Method	Amex Cheque Interac Mastercard Visa
Card No.
Expiry Date
Name on Card
Card Holder Signature