Common use of USA Hockey Clause in Contracts

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. 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 #Number: 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 $50,00025,000, 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 ❑ Asthma ❑ Allergies (concussion, skull fracture) ❑ High blood pressure ❑ Diabetes ❑ Fainting spells ❑ Kidney problems ❑ Other ❑ Convulsions/epilepsy ❑ Hernia _________________________ ❑ 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. 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. 3Ca Rev 6/21 I have received the 2024-2025 USA Hockey and Compuware Youth Hockey Policies listed below and agree to abide by, implement, and enforce each of the policies.  Coaching Code of Ethics; Page 2  USA Hockey Declaration of Player Safety, Fair Play and Respect; Page 2  Racial/Derogatory Slurs; Page 2  Disciple; Page 2  Code of Conduct; Page 3  USA Hockey Concussion Information and Acknowledgement; Pages 4-5  USA Hockey One-On-One Interactions Policy; Page 5  Safe Sport Reporting Policy; Pages 5-6  Compuware Youth Hockey’s Social Media and Electronic Communications Policy; Pages 7-9  Compuware Youth Hockey’s Locker Room Policy; Pages 10-12  Compuware Youth Hockey’s Proper Conduct, Weapons & Dangerous Materials Policy; Page 13  Compuware Youth Hockey’s Travel Policy; Pages 14-17  USA Hockey One-On-One Interactions Policy (Adopted by Compuware Youth Hockey); Pages 18-19  USA Hockey Parental Consent Forms (Adopted by Compuware Youth Hockey); Pages 19-20  USA Hockey Protective Equipment; Pages 21-22  Images; Page 22 ASSISTANT COACH Coach’s name: please print Coach’s signature: please sign Today’s date: It’s important that as coaches, we educate our children as to what is acceptable and what is not, and to make sure we practice what we preach. And when kids or adults step out of line, we must hold them accountable and help them learn from their mistakes. Behavior that is hurtful to others in any capacity has absolutely no place in our sport and is something we have zero tolerance for at USA Hockey/Compuware Youth Hockey. Coaching Code of Ethics The Coaching Code is intended to provide both the general principles and the decision rules to cover most situations encountered by coaches. It has as its primary goal the welfare and protection of the individuals and groups with whom coaches work. This Code also provides a common set of values. It is the individual responsibility of each coach to aspire to the highest possible standards of conduct. Coaches should respect and protect human civil rights and should not knowingly participate in or condone unfair discriminatory practices. As part of the USA Hockey Background Screening application, I acknowledge I was asked to review the USA Hockey Code of Ethics and agree to abide by it. Also posted at xxxxxxxxx.xxx, ‘Coaches’, ‘Manuals & Guides’. USA Hockey Declaration of Player Safety, Fair Play and Respect I acknowledge I was asked to review the policy and agree to abide by it. Posted at XxxxxxxxxXxxxxx.xxx, ‘Parents’, ‘Safety Declaration’. Racial/Derogatory Slurs Anyone penalized under Rule 601 (e.3) will receive a match penalty, which carries a five- minute penalty, disqualification from that game, and suspension from further participation until such time the governing Affiliate (the MAHA) has conducted a hearing to review the matter. This can occur anywhere in the rink before, during or after the game. Affiliates have up to 30 days to investigate and conduct a hearing and the offending individual(s) is subject to further discipline.