2019-20 TEAM STAFF AND VOLUNTEER REGISTRATION

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PLEASE NOTE: You must have a 2020-21 USA Hockey number in order to complete this registration. (Jr Ducks and Lady Ducks staff must also have a 2020-21 SCAHA Passcode)
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Program(s)* This field is required.Select all that apply
ADHSHL
Jr Ducks
Lady Ducks
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
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USA Hockey #* This field is required.Must be for 2020-21 or 2021-22 (no other season numbers are valid)
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SCAHA #* This field is required.
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Jr DucksSelect all that apply
Jr Ducks 18U AAA (Aiken)
Jr Ducks 18U AA-1 (Perkins)
Jr Ducks 18U AA-2 (Maxwell)
Jr Ducks 16U AAA (Kim)
Jr Ducks 16U AA-1 (Noviello)
Jr Ducks 16U AA-2 (Miller)
Jr Ducks 16U A (Strothers)
Jr Ducks 15U AAA (Walker)
Jr Ducks 14U AAA-1 (Tiveron)
Jr Ducks 14U AAA-2 (Caban)
Jr Ducks 14U AA-1 (Pegula)
Jr Ducks 14U AA-2 (Vasilevski)
Jr Ducks 14U A (Birkle)
Jr Ducks 14U A (Maxwell)
Jr Ducks 14U A (Surdin)
Jr Ducks 14U B (Ticorat)
Jr Ducks 12U AAA-1 (Kabanets)
Jr Ducks 12U AAA-2 (Burcar)
Jr Ducks 12U AA-1 (Gasseau)
Jr Ducks 12U AA-2 (Vasilevski)
Jr Ducks 12U A (Gasseau)
Jr Ducks 12U A (Marchant)
Jr Ducks 12U A/BB (Hutch)
Jr Ducks 12U A/BB (Love)
Jr Ducks 10U A (Labbe)
Jr Ducks 10U A/BB (Birkle)
Jr Ducks 10U BB/B (Love)
Jr Ducks 10U BB (Wilkerson)
Jr Ducks 10U B (Raimondo)
Jr Ducks 8U A ( Connelly)
Jr Ducks 8U A (Kabanets)
Jr Ducks 8U A (West)
Jr Ducks 8U B (Benson)
Jr Ducks 8U B (Vishnevski)
Jr Ducks 8U B (West)
JD Teams
Coach
Manager
Locker Room Monitor
Other
JD Position
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Lady DucksSelect all that apply
Lady Ducks 19U AAA
Lady Ducks 19U AA
Lady Ducks 16U AAA
Lady Ducks 16U AA
Lady Ducks 16U A
Lady Ducks 14U AAA
Lady Ducks 14U AA
Lady Ducks 12U AAA
Lady Ducks 12U AA
Lady Ducks 10U-1
Lady Ducks 10U-2
Lady Ducks 8U-1
Lady Ducks 8U-2
LD Teams
Coach
Manager
Locker Room Monitor
Other
LD Position
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ADHSHL
Beach Cities
Bishop Amat
Capistrano United
Carlsbad
Central Cathedral
Corona Norco
Damien
Edison
Fairmont
Inland Empire United
Irvine United
JSerra
La Jolla Country Day
Los Alamitos
Mater Dei
Newport Mesa
North County
Orange Lutheran
Pacific Ridge
Placentia Yorba Linda
Poway
Saddleback
Santa Margarita
Servite
St John Bosco
Tustin Unified
UCA Hockey
Villa Park
ADHSHL Teams
Coach
Manager
Locker Room Monitor
Other
ADHSHL Position
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Team Staff and Volunteer Agreement* This field is required.I understand that I, as a Team Representative, must complete and maintain current at all times, the registration requirements for my position as spelled out in the TEAM STAFF & VOLUNTEER REGISTRATION REQUIREMENTS. I also understand that I must complete all necessary requirements prior to my participation as a team representative. I understand that my actions as a Team representative are subject to the USA Hockey Playing Rules, Guidebook and Codes of Conduct and by the rules and regulations set forth by CAHA, SCAHA, IIFAHA, the ADHSHL, and The Rinks (as applicable for my position) and that regardless of my knowledge of the same, I understand that my actions will be gauged by their content and agree to conduct myself accordingly I have reviewed, understand and agree to be bound by the USA Hockey Code of Ethics. I understand that violations of the Ethics Code may result in the full or partial forfeiture of my privileges in programs sanctioned by USA Hockey and/or its various affiliates. I further understand that lack of awareness or a misunderstanding of an ethical standard on my part is not a defense to a charge of unethical conduct I will conduct myself in a manner conducive to good sportsmanship by refraining from abusive, obscene, or threatening language or gestures, physical violence, and any behavior that would be considered unsportsmanlike or would disrespect the game, its players, coaches, officials, parents, or spectators. I understand that as a Team Representative I am a role model to youth and young adult players and ensure my actions both on and off the ice are appropriate Resolution of disputes shall be in accordance with and subject to the applicable bylaws, rules and regulations of The Rinks, IIFAHA, ADHSHL, SCAHA, CAHA, and USA Hockey as they apply to my position. I understand that, subject to an applicable hearing, any failure to comply with these conditions could subject myself to immediate suspension, fines, and/or the revocation of my privilege as a Team Representative.CONCUSSION PROTOCOL: I understand that the Pacific District of USA Hockey has adopted concussion-related education, awareness, and protocol into their policies and procedures. I understand the following guidelines and protocol exist, and will respect them if they must be instituted for any individual on the team. An athlete who is suspected of sustaining a concussion or head injury shall be immediately removed from participation for the reminder of the day. Removal can be at the request of a coach, official, team manager, parent/guardian, or the athlete. Athlete shall not be permitted to return to participation until he/she is evaluated by a medical professional trained in the management of concussions, and acting within the scope of his/her practice. Acceptable evaluators should be medical professionals with one of the following medical license designations: MD, DO, Neurologist, Neuropsychologist The athlete shall not be permitted to return to participation until he or she provides the approved and completed Concussion Release form to its member program (head coach, team manager, or registrar) Should it be determined that an athlete needs to be removed from participation, I understand that the protocol outlined herein shall be followed for the safety of the athlete. I understand that if a suspected concussion has occurred and protocol has been enacted for an athlete, there is no review period or negotiation as to the course of action and return to participation outside of the recommendations of the evaluating medical professional who has been selected to treat the athlete.
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THE RINKS / GREAT PARK ICE / LEAGUES & TEAMS CONSENT, INDEMNIFICATION, WAIVER AND RELEASE AGREEMENT* This field is required. FOR AND IN CONSIDERATION of my and, if a child’s name is written below (“My Child”), My Child’s participation in activities related to the Jr. Ducks, Lady Ducks, Jr. Gulls, Jr. Gulls Girls and/or Anaheim Ducks High School Hockey League (individually and collectively, the “Teams”) and/or being at and/or using of any of the premises and facilities commonly known as Great Park Ice or The Rinks (individually and collectively, the “Facility”), including transportation to and from, and any equipment supplied to me or My Child or used by me or My Child in connection therewith (collectively, “Participation”), all as applicable and to the fullest extent permitted by applicable laws, I agree as follows: 1. I acknowledge that the risk of exposure to the virus that causes COVID-19 (“COVID-19”) exists in any place where people are present and that COVID-19 is an extremely contagious disease that can lead to severe illness and death. By engaging in the Participation, including, for example, entering the Facility, I voluntarily assume on my behalf and on behalf of My Child all risks of exposure to COVID-19. I agree to abide by, and ensure My Child abides by all COVID-19-related rules, suggestions and guidelines of the Facility, including, without limitation, compliance with proper physical distancing guidelines and completion of health declarations. Facility has not made, and I am not relying upon, any representation or warranty, express or implied, that the Facility or any employees, patrons, guests or employees are free from COVID-19 or that any particular precautions, actions, preventions or disinfecting in and around the Facility is effective in the prevention of or exposure to COVID-19. I agree that I (or My Child) will not engage in the Participation, including for example, entering the Facility, if I (or My Child) have COVID-19, is suspected to have or exhibits or experiences COVID-19 symptoms and shall notify the applicable Facility and Teams (as and if applicable) of such symptoms or if I am (or My Child is) found to have COVID-19 within fourteen (14) days prior to or after the Participation. Facility reserves the right to condition or refuse entry to me or My Child based upon information received or upon guidelines or requirements provided by governmental authorities and agencies (including without limitation, the Centers for Disease Control and Prevention), industry recommendations, or otherwise pursuant to Facility’s own guidelines, regulations or independent determination. If requested, including without limitation, prior to and as a condition of entering the Facility, I consent to health screenings by a representative or agent of Facility, including without limitation, temperature measurement and health questionnaires. 2. In addition to Section 1, above, I acknowledge and I am aware of the hazards, dangers and risks (inherent or otherwise) in connection with the Participation and being a spectator, including, without limitation, exposure to or transmission of bacteria and viruses, property damage, property loss, property theft, economic loss, accident, minor injury or serious injury (known or unknown), which may include permanent disability or paralysis, or death to me, My Child, to other participants, to spectators or other third parties (collectively, “Injury”). I further acknowledge that there are natural factors and occurrences which may impact or affect the safety of the Participation. I warrant that I am, and My Child is, in good health and has/have no physical conditions that would prevent me or My Child from being involved in or acting in connection with the Participation. 3. I assume full responsibility for, and all risk of, any illness, accident, bodily injury, death, property loss, property theft or property damage that may result for any reason, including by acts of negligence, in connection with the Participation and being a spectator, whether caused by Irvine Ice Foundation, Ice Management, LLC, Huntington Beach Roller Rink, LLC, Irvine Roller Rink, LLC, San Diego Gulls Hockey Club, LLC, the Facility, and/or its parent, related affiliate, agent, successor and/or subsidiary companies (and/or their respective owners, officers, directors, members, employees, agents, subtenants, ground lessors, landlords and/or sublandlords) (collectively, the “Releasees”), me, My Child, another participant, any third persons or otherwise. 4. I agree that prior to participating, or allowing My Child to participate, in any activity relating to the Participation, including, without limitation at the Facilities, I will inspect the premises and surrounding area and all equipment to be used. If through my inspection I determine that anything related to the Participation is unsafe, I will immediately advise an official of the applicable Facility and Teams (as and if applicable) of the unsafe condition and will not participate, or allow My Child to participate, until the condition is corrected. 5. If I or My Child become injured or ill as a result of the Participation, I authorize the Releasees to administer, or cause and consent to the administration of, whatever first aid, medical care, dental care or other treatment and medications as may be necessary under the circumstances, including treatment by a physician, emergency medical technician, dentist or hospital (“Treatment”), although I acknowledge that the Releasees have no obligation to do so and that the Releasees do not endorse the services of any physician or hospital that may provide such Treatment to me or My Child. I understand that I will be financially responsible for the cost of any such care, treatment or medication and that the Releasees will have no obligation to pay any such costs of any Treatment and agree to reimburse the Releasees for any such costs incurred. 6. I RELEASE, AGREE NOT TO SUE AND AGREE TO INDEMNIFY AND HOLD HARMLESS (ON BEHALF OF MYSELF AND MY CHILD) THE RELEASEES of and from any and all claims, causes of action, suits, demands, damages, losses, liabilities, costs, expenses and any actions of any kind whatsoever (collectively, "Claims"), known or unknown, existing now or in the future, that I, My Child, our respective heirs, executors, administrators, next of kin, assigns or any third party may now or hereafter have against the Releasees, arising in any way as a result of or in connection with the Participation and any Treatment, including, without limitation, any Injury suffered by me, My Child, our respective heirs, executors, administrators, next of kin and assigns or any other party and regardless of any fault or passive or active negligence on the part of the Releasees, myself , My Child, or any third party. I (on behalf of myself and My Child) expressly waive and relinquish all rights and benefits afforded by California Civil Code Section 1542 and do so understanding and acknowledging the significance of this specific waiver of Section 1542. Section 1542 states as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS THAT THE CREDITOR OR RELEASING PARTY DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE AND THAT, IF KNOWN BY HIM OR HER, WOULD HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR OR RELEASED PARTY.” 7. I grant to the Releasees, and any person or entity acting under the Releasee’s permission or with the Releasee’s authority, permission to photograph, film, videotape or record me or My Child while at the Facility, and a non-exclusive license to use the likeness, image, photograph and name of me and My Child for any and all commercial and non-commercial purposes in perpetuity including, without limitation, in connection with the marketing, promotion and/or advertising of the Facility, the Teams, the Anaheim Ducks, the San Diego Gulls, the Releasees, and/or their affiliates and their respective programs in any media known and unknown or hereinafter developed without geographic or time restrictions. 8. This Agreement constitutes my entire understanding regarding the subject matter of this Agreement and supersedes any prior statements, agreements or representations (written or oral) regarding that subject matter. No oral representations, statements or inducements apart from this Agreement as written have been made to me. I agree that this Agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, such invalidity will not affect any other provision that can be given full effect without the invalid provision. 9. BINDING ARBITRATION: This Agreement and any dispute or Claims whatsoever between me (or My Child) and the Facilities, Teams and Releasees, including, without limitation, my or My Child’s Participation and any Injury or Treatment, shall be governed by and construed in accordance with the internal laws of the State of California exclusive of conflict or choice of the law rules and, subject to the following provision related to arbitration of disputes, the parties consent to the exclusive jurisdiction of the Superior Court of the State of California for the County of Orange. Any dispute or Claims between me (and/or My Child, as applicable) and the Facilities, Teams and Releasees, including without limitation, arising out of or relating to this Agreement, my or My Child’s Participation, any Injury, any Treatment and the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in Orange County, California before one arbitrator. The arbitration shall be administered by JAMS pursuant to JAMS’ Streamlined Arbitration Rules and Procedures. The arbitration proceedings and award shall be confidential, except as otherwise required by court order or as necessary to confirm, vacate or enforce the award and for disclosure in confidence to the parties’ respective attorneys, advisors and family members. Judgment on the award may be entered in any court having jurisdiction. This provision shall not preclude a party from seeking provisional remedies in aid of arbitration from the Superior Court of the State of California for the County of Orange. Each party shall bear its own costs and fees of arbitration. 10. I have carefully read this Agreement, and I know and understand what it means, including that it is a complete waiver and release of liability, a waiver of a jury trial and promise on behalf of myself and My Child to indemnify and not to sue or make a claim. My signature below is my own free and voluntary act and I intend this Agreement to be legally binding on me. I certify that I am at least 18 years old. 11. I represent, if this waiver is for My Child, that I am a parent and natural guardian of My Child and that I am, in fact, acting in such capacity and agree to save and hold harmless and indemnify the Releasees from all Claims, whether known or unknown, which may be made against the Releasees because of any defect in or lack of such capacity to so act and hereby release the Releasees on behalf of My Child and other his/her parent(s) or legal guardian(s).
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