Ottawa Travellers Athletic Club

Player Waiver/Registration

Name

First Name	Last Name

Address

Street Address	City	Province/State	Postal/Zip Code

Telephone Numers

At least Phone 1 is required (example 613-555-9999):
Home
Office
Mobile

Date of Birth

Sex

Male Female

Position you currently play

Skater
Goalie
Skater and goalie

Select your highest level played (or equivalent):

As a skater	Predominantly: Forward Defence
As a goalie

Identify team(s) you are registering for

I'm on the following team(s):

+ Add myself to another team roster If your team is not listed, contact your team rep.

I'm not on a team yet but I want to pre-register in order to spare or join a team full time for

Sign Waiver

I, the herein named person, in consideration of the application being accepted by the Ottawa Travellers Athletic Club, do hereby agree to release, and discharge and forever save harmless the said organization, its officers, directors, employees and agents, from claims for loss, injury, or damage which we or any person claiming through us or on our behalf, may at any time have, arising out of, or connected with, the operation of the said organization or any of its activities or any time done or maintained in connection therewith. Where applicable, this waiver will survive into upcoming seasons.

I have read and agree to abide by the Ottawa Travellers Athletic Club's League Rules which I am aware are posted on the Ottawa Travellers Athletic Club Site.

By checking this box, I, , declare that I understand and agree to the terms and conditions of the waiver outlined above.

If you are listed below, select your profile to submit the waiver/registration.

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	Summer Medical/Dental Coverage Plan ($8.95) Optional Accidental Medical-Dental Expenses Coverage Coverage for Travellers Summer Season Only ($8.95) $5,000 Accidental medical expenses coverage $2,500 Accidental dental expenses coverage (no facemask restrictions) This optional coverage is available online to individual players participating on a Travellers Hockey League team. Cost is $8.95 per person (includes processing fees and applicable taxes). Coverage is portable: You are covered when playing for your Travellers team(s) in the Travellers Hockey League, when your Travellers team(s) is/ are playing against non-league teams, or when your Travellers team(s) is/are playing shinny. Coverage period begins the later of time/date of purchase or April 10, 2012, and expires August 31, 2012. View policy details and claim information (PDF)

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	A confirmation email has been sent to .

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