East Alton Ice Arena
631 Lewis and Clark Blvd., East Alton IL 62024
Phone: (618) 254-7465
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2018 Youth Spring League - Mite/Squirt/PeeWee
Player's First Name (no nicknames):
Player's Middle Initial:
Player's Last Name:
Parent 1 Name:
Parent 2 Name:
Secondary Email Address:
Waiver of Liability
CONSENT WAIVER:: I, the undersigned player, parent or legal guardian of the above named player, or minor player, do hereby give consent to the East Alton Ice Arena, and East Alton Civic Rink Management, Inc. its agents, officers and representatives for emergency medical treatment to be rendered to the above named player, or minor player, in event of injury occurring in the course of participation in the East Alton Ice Arena Spring Hockey League. I further state that I am aware that ice hockey is a physically demanding sport, involving physical contact, and knowing this give the above named player or minor permission to fully participate in the spring leagues. I release the East Alton Ice Arena, and East Alton Civic Rink Management, Inc., its agents, officers and representatives from any liability for injuries or other loss as a result of such participation. Furthermore, I agree to abide by the rules and regulations as set forth from USA Hockey playing rules, and the East Alton Ice Arena, as they pertain to these spring league programs. I further state that I have attached, INITIAL IF ATTACHED, ( ) a statement of any disabilities, disorder or medical conditions or limitations for the above named player.
I accept the Waiver of Liability terms
I further state that I will provide a statement of any disabilities, disorder or medical conditions or limitations for the above named player.
Player Background Information
Last Seasons Experience Level:
Division you are Signing up to Play in:
USA Hockey 2018 membership number**:
to print a copy of your 2018 membership number
** Player’s without a 2018 number must first register on-line with
to complete this signup.
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