Open Tryouts for EJHL(JR. A’s) and Empire Team(Jr.B’s)
April 26th & Sunday, April 27th Knickerbacker Rec. Facility, Troy, New York
Saturday 12:00pm-8:00pm
Sunday 12:00pm-5:20pm
Cost is $130.00 pay via PayPal (on website www.cdselects.com) or forward your check payable to:
CD Selects, 19 Oakwood Blvd., Clifton Park, NY 12065
Print Form and Fill Out Completely and mail ASAP or Return by Fax
Questions? Contact Jim Salfi 518-459-1707(PH/Fax)
Or 518-371-3795 Or
Name:______________________________ DOB___________Height_______Weight_______
Address:________________________________________________________________________
Street City State Zip
Home Phone:______________________Cell_________________Fax_____________________
School:________________________________Grade:_______________________(2007/2008)
Cumulative GPA:__________SAT__________ DATE_________ACT______________________
Parents:___________________________________________________________________
Parent’s E-Mail______________________ Player’s e-mail_______________________
Player Position:____________________ Shoots: Left or Right___________________
**2007-2008 Season Team:_______________________________
Goals:______Assists:______Pts:______Pims:_____GAA:______SA%:______
Payment Method(Circle one) Enclosed Check PayPal Pay at Arrival
Release and Indemnity Agreement: I, parent of____________________________,acknowledge that hockey is a contact sport and sometimes can result in physical injury or other damages. I agree that CD Selects, its’ officers, coaches, volunteers and employees shall not be liable to me or the above named player for any injury or damage resulting directly or indirectly from any participation with the CD Selects. In consideration of the CD Selects accepting the above named player, the undersigned hereby acknowledges and agrees that, the undersigned will defend and discharge and hold harmless the CD Selects and any of their officers, coaches, volunteers and employees, from and against all claims, judgements, liabilities, including attorney’s fees, for any injuries or damages arising out of or resulting from the above named player’s participation in any way with the CD Selects, including without limitation any injuries or damages incurred. Date_______Parent Signature,_______________________ Player Signature,___________________
Consent for Medical Treatment of a Minor:
I, being the parent/guardian of the above named minor, do hereby appoint Jim Salfi, CD Selects, to act on my behalf in authorizing emergency medical, dental, surgical care and hospitalization for the above named minor. Date_______Parent Signature,_______________________Player Signature,___________________
