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Harrigan Hockey Inc is excited to have its participants back on the ice. To ensure the safety of all participants, family, staff, and community, we ask that you complete this form prior to accessing any program or facility. Anyone who has not completed the form will be deined access to Harrigan Hockey Inc programming.

~~Liability Waiver
I, the undersigned, being the Participant or as the parent or legal guardian of the Participant noted above, am responsible for my conduct or that of my child as Participant while participating in this program. The Participant shall be governed by Harrigan Hockey Inc. It is understood that the undersigned person of legal age or legal guardian shall not hold Harrigan Hockey Inc. or their instructors, administrators, officials liable in the event of injury or loss.
 The Participant listed above is registered under the care of the undersigned and assumes all risks of physical injury and resulting loss, costs and damages through enrolment and participation in this program with the understanding that although play is, in most cases, “Non-Contact”, it consists of physical interaction capable of causing injury. The Participant must wear all approved hockey equipment including helmet, full face mask, shin pads, elbow pads, hockey gloves, shoulder pads, hockey pants, neck guard, and hockey shirt. Although mouth guards are not mandatory, Harrigan Hockey Inc. recommends that they should be worn. All participants are to advise Harrigan Hockey Inc. in writing of any medical conditions that increase risk to themselves or other participants.

Coronavirus (“Covid-19”)
I/We acknowledge that the world health organization has classified the Coronavirus (“Covid-19”) outbreak as a global pandemic and am/are aware of the risks of Covid-19. I/We specifically acknowledge and agree that I am/we are aware of the risks to personal health, including by the failure to follow physical distancing and all other protocols, flowing from COVID-19, and that I am/we are assuming, on my/our own behalf and, if signing on behalf of a participant under 18 years, on his or her behalf, all health risks and adverse health related consequences caused by or arising from engaging in any Activities with Harrigan Hockey Inc. I hereby indemnify you from any claim made by or on behalf of the Participa[ag

I Agree

August 8, 2020

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Program*
Involvement*
Facility*
Program/Game Time*
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Please indicate Yes or No: Do you have any of the following symptoms:
Cough **
Please Choose
No
Yes
Fever (greater than 38.0C)**
Please Choose
No
Yes
Shortness of Breath / Difficulty Breathing **
Please Choose
No
Yes
Sore Throat **
Please Choose
No
Yes
Runny Nose **
Please Choose
No
Yes
Have you, or anyone in your Household travelled outside of Canada in the last 14 days?**
Please Choose
No
Yes
Have you, or anyone in your Household been in contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?**
Please Choose
No
Yes
Are you currently being investigated as a subject case of COVID-19?**
Please Choose
No
Yes
Have you tested positive for COVID-19 in the past 10 days?**
Please Choose
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Program*
Involvement*
Facility*
Program/Game Time*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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