Twizzit

NEW MEMBER REGISTRATION FORM

Player Name *

E-mail *

Player Gender *

Player Date of Birth *

Player Nationality *

Luxembourg Nationality? *

Please upload copy of Luxembourg passport *

Player Social Security Number *

Medico-Sportif *

Document to share with the club ideally before registration : Valid Medico-Sportif document.

For more information about the procedure, contact info@hockey.lu

Name of father (if player is under 18 years old) *

E-mail *

Name of mother (if player is under 18 years old) *

E-mail *

You would like to register for : *

Your comments (eg. specify the team you want to join if you already know) *

Hockey Experience (Years) *

Address *

Phone *

I recognize and agree that neither Hockey Club Luxembourg nor any of its board members, trainers, coaches or volunteers (collectively “LHC”) can be held liable for any damages that may occur during the practice sessions, games, tournaments or any related activities (the “LHC Activities”).

I shall indemnify and hold harmless LHC, as well as any third party cooperating with LHC for any LHC Activities, against all damages that I may cause or incur during the LHC Activities. I declare having sufficient third party liability insurance to cover such event. I consent to any emergency medical treatment necessary during the course of the LHC Activities. I also understand that LHC requires all players to have sufficient medical insurance covering their participation in the LHC Activities; I confirm that I checked that our medical insurance covers hockey. I confirm that I agree to my child participating in the LHC Activities. I also confirm that if for medical or disciplinary reasons my child has to return home I will promptly collect or arrange for my child to be collected. I understand that LHC has a zero tolerance policy with regard to bad language and lack of respect for coaches and other players.

I understand that membership and participation in the LHC Activities can only be accepted upon receipt of the amount due and receipt of this registration form duly signed. I consent for the details on the form below to be held on the LHC database.

I confirm that I agree to the conditions listed above: *

Agree

Do Not Agree

Registration is considered by LHC to be automatically renewed season over season. In order to unregister as a member, please complete the Twizzit form to deregister.

Date *

NEW MEMBER REGISTRATION FORM

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