Blueliners
Club, dba Poland-GNG Hockey is a non-profit organization, which sponsors hockey
for youngsters grades 9-12 in Union 29 and MSAD 15 and any youths residing
in these school districts. Poland-GNG Hockey provides coaches, referees
and ice time. A team jersey is supplied
by Poland-GNG Hockey and must be returned in the condition in which it was
received. The Board reserves the right
to charge for missing/lost jerseys or for extensive damage to a jersey (Poland-GNG
Hockey reserves the right to define extensive damage). More information can be
found at www.polandgnghockey.com.
PARTICIPANT: Last Name __________________________ First Name _______________ MI _____
CIRCLE ONE: RETURNING PLAYER NEW PLAYER
PARENT/GUARDIAN: Last Name ____________________ First Name _______________ MI _____
Position ___________________________
Mailing
Address ___________________________________________________________________________
City________________________ ME Zip:______________________
Participant
Birth date____________________ Grade
Entering 2007 _________________________
Home Telephone_______________________ Alternate Telephone (work or cell) _____________________
EMAIL
___________________________________
As the parent or legal guardian of the above named
participant, I understand that by signing this form, I assume all financial
responsibility for the assessment(s) charged by Poland-GNG Hockey for my child
to play hockey. I understand that as a
member of Poland-GNG Hockey the participants name and/or photo may be submitted
to the local newspaper, unless I request, in writing to Poland-GNG Hockey, to
exclude my child from any such article or picture.
Parent/Guardian Signature X______________________________________ Date______________
Payment of Assessment:
Poland-GNG Hockey must receive this signed, completed form in order
to register.
A non-refundable $100.00
deposit is required at the time of registration
Balance is due in full by
December 1, 2007. After this date, a
player will not be allowed to participate in practice or games until balance is
paid in full.
NO REFUNDS (with the exception of
injury, which the Board will only consider upon written request)
MAIL COMPLETED FORM TO: BLUELINERS CLUB
Payment may be made via
personal check or MC/VISA
MC VISA
Card #_________________________ Name on Card__________________________
Expiration
Date____________________ Signature________________________________
Please do not write below
this line:
BOARD USE ONLY:
DATE REGISTRATION ACCEPTED:
___________________________________________
AMOUNT OF DEPOSIT: ______________
CK #: _______________
REGISTRATION ACCEPTED BY: ______________