CAPITAL CITY VIPERS YOUTH HOCKEY CLUB, INC. 129 Litchfield Road, Harrisburg, PA 17112 dvhlcityvipers.pointstreaksites.com 2015-2016 PLAYER REGISTRATION FORM Check Level: o Mite o Squirt o PeeWee o Bantam o Midget 16 o Midget 18 1997 – 1998 = Midget 18 1999 – 2000 = Midget 16 2001 – 2002 = Bantam 2003 – 2004 = PeeWee 2005 – 2006 = Squirt 2007 & younger = Mite Name:___________________________________________________________________________________________ (Last) (First) (Middle) Address:_________________________________________________________________________________________ (Street) ________________________________________________________________________________________________ (City/State) (Zip Code) Home Phone:_____________________________________________________________________________________ Email address (father):______________________________________________________________________________ Email address (mother):_____________________________________________________________________________ Date of Birth: (mm/dd/yy)_____________________________________________ o Male o Female Father’s Name:_________________________________ Mother’s Name:____________________________________ Cell Phone #___________________________________ Cell Phone #_______________________________________ Previous Year Club & Level (Vipers or other):___________________________________________________________ # Years of Travel Hockey:________________ School District and 2015-16 Grade:____________________________________________________ _____________ I hereby acknowledge that I am registering to play for the Capital City Vipers Youth Hockey Club for the 2015 – 2016 season. I am not registered with another DVHL Club for this season and agree that I will be financially committed to the Capital City Vipers. I understand that, if payments are not made in full by October 31, 2015, my son/daughter will no longer be able to play or practice until payment is current. If not paid in full by February 1st, the player’s name will be placed on the AAHA financial list (according to AAHA Rule 17) and will not be able to play for the remainder of the season. _____________________________________________ __________________________________________________ PLAYER SIGNATURE _____________________________________________ DATE PARENT/GUARDIAN SIGNATURE CAPITAL CITY VIPERS YOUTH HOCKEY CLUB, INC. 129 Litchfield Road, Harrisburg, PA 17112 dvhlcityvipers.pointstreaksites.com 2015-2016 REGISTRATION FEES & PAYMENT POLICY Season fees and payment schedule is as follows: LEVEL TOTALAPRIL MAY JUNE JULY AUG SEPT MITE LIMITED TRAVEL $600$100$250$250 MITE DVHL $800$100$250$250$250 SQUIRT $1750$300*$300$300$300$300$300 PEEWEE $1750$300*$300$300$300$300$300 PEEWEE AA $1950$300*$350$350$350$350$350 BANTAM $1750$300*$300$300$300$300$300 MIDGET 16A & 18A$1750$300*$300$300$300$300$300 $470 $470 MIDGET 16AA $2600$300* $470 * $50 non-refundable evaluation fee does not count toward season fees ** Squirt to Midget Goalies $1,100 ** Please make all checks payable to: Capital City Vipers Youth Hockey Club For families with multiple children in our organization, a $200 discount will be given to the second child. For payment made in full by May 31st, the Capital City Vipers will provide a $50 payment in full discount. ** Discounts do not apply to children at the Mite Level ** Current players must fulfill any outstanding financial obligation to the Capital City Vipers or any other DVHL team before they are allowed to register. Please complete the registration form and send it, along with your check for the non-refundable evaluation fee of $50 and 2015-16 USA Hockey registration page to our Registrar: Tonya Burd Registrar, Capital City Vipers 1263 Hillside Drive Mechanicsburg, PA 17055 Monthly Payments should be mailed to: Lisa Kelly Treasurer, Capital City Vipers 129 Llitchfiled Road Harrisburg, PA 17112 All payments due at the end of every month. CAPITAL CITY VIPERS 2015- 2016 PAYMENT POLICY In an effort to ensure that the Viper organization maintains its financial stability, while maintaining a fun environment for the families involved, the following is the Viper payment policy. Other payment arrangements can be made at the discretion of the Board based on individual circumstances. For non-payment: When a payment is 15 days late the parents will be notified that they have 15 days to become current or their son/daughter will be suspended from further team activities until they are current with their financial responsibilities. If they fail to make payment within 15 days, the player is suspended indefinitely from further team activities up to and including practices and games. The player will not be reinstated until the family financial responsibilities have been met. The coach of the respective team will be directed to not play that player or allow them to participate in any team activity until that time. CAPITAL CITY VIPERS YOUTH HOCKEY CLUB, INC. 129 Litchfield Road, Harrisburg, PA 17112 dvhlcityvipers.pointstreaksites.com 2015-2016 Hockey Season Player Name:_________________________________________________________________ Level:________________________________________________________________________ ______ Vipers Registration Page ______ Proof of USA Hockey Registration 2015-16 Season ______ DVHL Code of Conduct 2015-16 ______ DVHL Player/Parent Agreement Form 2015-16 ______ USA Hockey Consent to Treat / Medical History Form ______ Copy of Birth Certificate (new players only) ______ $50 Evaluation Fee check #_______ ______ $250 Registration Fee check #_______ All forms are required to be turned in at registration or your child will not be permitted to take the ice for evaluations. No exceptions.
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