1. Complete this form.
2. Confirm subscription to Komoka 5 on 5 Spring Hockey. (You will receive an email after completing this form. If you don't see it - check your spam or junk folder).
3. Remit payment of $175.00 (Early Bird registration only $165.00 if paid before February 15th).

Payment Options:
Cash: Can be dropped off to 102 Harris Road, Delaware or 8046 Scotchmere Drive, Strathroy
Electronic Transfers: Can be emailed to
Cheque or Money Order: Can be mailed to Komoka 5 on 5 Spring Hockey League, 102 Harris Road, Delaware, ON N0L 1E0

Athletic Waiver and Release of Liability
This agreement is part of the registration package for the minor participant being registered herein who is a minor to participate in the program and all related activities to the program for the Komoka 5 on 5 Spring Hockey/Komoka Icemen program.
In this Agreement, Komoka 5 on 5 means Komoka 5 on 5  Spring Hockey League/Komoka Icemen and its organizers, officers, directors, agents, employees, independent contractors, volunteers, minor participants and Komoka Wellness and Recreation Complex.
I agree to the terms and conditions of this Agreement on my own behalf and on behalf of the Minor and our respective heirs, executors, personal representatives, administrators, assigns, and next of kin.
I confirm that Komoka 5 on 5 as defined above is not responsible for the transportation to and from any events or activities related  to the program.
I am the parent/legal guardian and I am responsible for making legal decision on behalf of the minor. I accept on behalf of the Minor, that there is always the risk of serious injury, paralysis or death resulting from participation by minors in sports programs and activities, including, but not limited to, complete or partial paralysis, serious injury to internal organs, serious injury to bones, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, and serious injury or impairment to other aspects of a child’s body, general health and well being. I confirm that the minor will be told and follow all rules and regulations for participation in the Program. The sole responsibility for personal safety remains with the Minor.  I will immediately remove the Minor from participation in the Program and will notify Komoka 5 on 5 owners if any unusual hazard or unsafe condition occurs.
I understand and agree that my execution of this document constitutes an unqualified assumption of all risks to the Minor of injury, death, property damage and property loss associated with the Minor’s participation in the Program, even if arising from negligence.

I further understand and agree that my execution of this document constitutes a FULL AND FINAL RELEASE AND WAIVER OF LIABILITY of Komoka 5 on 5 as defined above from all claims relating to, or resulting from, any risk.
I understand and agree that my execution of this document constitutes  an AGREEMENT NOT TO SUE any of the Releases for any loss, injury, costs or damages of any form or type, howsoever caused or arising, and whether directly or indirectly, relating to, or resulting from, any risks.

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