USA Hockey Sample Clauses

USA Hockey. Consent To Treat/Medical History Form This is to certify that on this date, I , as parent or guardian of , (athlete participant), or for myself as an adult participant, give my consent to USA Hockey and its medical representative to obtain medical care from any licensed physician, hospital, or clinic for the above mentioned participant, for any injury that could arise from participation in USA Hockey sanctioned events. If said participant is covered by any insurance company, please complete the following: Insurance Company: Policy #: This form may be signed by hand or signed electronically and returned to your team and/or program. If I sign this form electronically, I acknowledge that it shall have the same validity and effect as if I signed this consent by hand. Parent/Guardian/Adult Participant Signature: Date: Excess accident insurance up to $50,000, subject to deductibles, exclusions and certain limitations, is provided to all USA Hockey registered team participants. For further details visit xxxxxxxxx.xxx or contact USA Hockey at (000) 000-XXXX. EMERGENCY CONTACT Name: Phone: ( ) Address: City: State: Zip Code: Physician’s Name: Phone: ( ) Hospital of Choice: COMPLETION OF MEDICAL HISTORY INFORMATION BELOW IS OPTIONAL MEDICAL HISTORY If the answer to any of the following questions is yes, please describe the problem and its implications for proper first aid treatment on the back of this form. ❑ Head Injury (concussion, skull fracture) ❑ Fainting spells ❑ Convulsions/epilepsy ❑ Neck or back injury ❑ Asthma ❑ High blood pressure ❑ Kidney problems ❑ Hernia ❑ Heart murmur ❑ Allergies ❑ Diabetes ❑ Other Have you had (or do you currently have) any of the following? Have you had a recent tetanus booster? ❑ Yes ❑ No If yes, when? Are you currently taking any medications? ❑ Yes ❑ No If yes, please list all medications on back. Has a doctor placed any restrictions on your activity? ❑ Yes ❑ No If yes, please explain on back.

USA Hockey. ZERO TOLERANCE POLICY In an effort to make ice hockey a more desirable and rewarding experience for all participants, the USA Hockey Youth, Junior and Senior Councils have instructed the Officiating Program to adhere to certain points of emphasis relating to sportsmanship. This campaign is designed to require all players, coaches, officials, team officials, administrators and parents/spectators to maintain a sportsmanlike and educational atmosphere before and during and after all USA Hockey-sanctioned games. Thus, the following points of emphasis must be implemented by all On-Ice Referees and Linesmen: Players A minor penalty for unsportsmanlike conduct (Zero Tolerance) shall be assessed whenever a player:

USA Hockey. Players must register with USA Hockey (xxx.xxxxxxxxx.xxx) before you register online with AYHL.