Player Name____________________________Age____D.O.B.________________
Address_______________________Phone________________Cell_____________
E-Mail_________________________________
Emergency Contact_____________________Phone_____________________
_____ Youth League @ $130 (10 games + playoffs)
(Sibling Discount = 2nd child is 20% off)
Please make check payable to: Miami Advice
Consent
I, the undersigned parent or legal guardian of ________________ or as an adult player, do hereby consent
and agree that the above named minor(or adult) may participate in the Suniland Roller Hockey program. I further agree
that the Suniland Roller Hockey program, including Miami Advice, volunteer officials, coaches and referrees and
other support persons, will not be held liable for any accidents which may result from the above-named person's participation
in said league's activities, including, but not limited to, games, practices, travel and/or being a spectator. It is further
agreed that this consent remain in full force and effect until such time as the undersigned parent or legal guardian (or adult
player) shall notify the Suniland Roller Hockey, in writing, of the cancellation of the consent.
Parent or legal guardian (or adult player)___________________________________________________
Bring to the Rink or Mail this form, with payment to : Richard
Stuck, 13720 SW 90 Ave., F, Miami, FL 33176
