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BW Hockey Waiver

This field is for validation purposes and should be left unchanged.

Participants Info

Participants Name(Required)
Address(Required)

1st Parent/Guardian Info

Parent/Gaurdian(Required)

2nd Parent/Guardian Info (Optional)

Parent/Gaurdian

Emergency Contact Info (Optional)

Emergency Contact Name

Pick-up / Sign-out Authorization

Authorized individual to pick-up / sign-out the participant (Full legal name)(Required)

Other Important Information

If no medical concerns, please simply state "None".
If no allergies, please simply state "None".

Consent to use photos

Consent to use photos(Required)
Your consent would be required for BW Hockey to publish pictures or videos of your child. By checking “Yes I agree” below, I understand that I am giving consent to BW Hockey to use and disclose my personal image (or the personal image of my child) for promotional and/or informational purposes such as brochures, flyers, and training videos.

Waiver

We are proud of our partnership with Janelle Anderson at Combined.

At BW hockey, we would like to offer a Peace Of Mind for families, so we are giving exclusive access to injury coverage for your youth/family on or off the ice!

Janelle will be reaching out to you individually to explain how it works & how you and your loved ones can be protected from the unexpected!

*Please be advised we are going to be passing your contact information on to our partnered Sports Injury Company. You will be hearing from Janelle about private coverage for your child which will help cover you for injuries on and off the ice. We will not be sending your information to any other 3rd party entities. Should you decide that you do not want to have your information shared please reach out to us via email at Info@bwhockey.com

Your Email Address(Required)
Please enter your email address so that we can send you a copy of the waiver.
Parent's/Guardian's Name(Required)
MM slash DD slash YYYY
Parent's/Guardian's Signature
Clear Signature

For further information contact: Brandon Wong (778) 677-6139

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