* Required Fields About you * Name: * Street Address: * City: * Province: * Postal Code: *  ( ) - Telephone: * Email:     Height: *   0 3 4 5 6 7 Ft   * 0 0 1 2 3 4 5 6 7 8 9 10 11 In * Weight: * MM 00 01 02 03 04 05 06 07 08 09 10 11 12  * DD 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  * YY 0000 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Date of Birth: Health Information Health Card No: Doctor’s Name: Doctor’s Contact No: Your Current Stats * Current Team Name: * Current Level: * Current Position: Father’s Information Father’s Name: Father’s Contact No: Father’s Email: Mother’s Information Mother’s Name: Mother’s Contact No: Mother’s Email: Any Extra Information you would like to pass along Extra Info: Waiver and Release Section By checking the box below: You hereby acknowledge that the sport of hockey has inherit risks of injury and       1. Release and discharge Durham Fury Hockey, it’s directors, employees and          agents (the “Releasees”) from any and all liability for any however occurring,          whether from negligence on the part of the Releasees or otherwise.      2. Agree to indemnify and save harmless the Releasees from any and all          causes of action brought against them for any injury however occurring. * <<<  * Waiver and release box must be                checked in order to Register