3.1 Alaska Warriors Hockey Participant Information Form

This is the general form for all participants. If you are the guardian of an adult please select Adult below and enter the participant's information. We will need a copy of the paperwork from the courts as well.

If completing for a child then select that option.

Who will be participating?

Adult Someone Under 18 or Legally Incapacitated

Signee Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Mobile Number *

Opt In to SMS alerts

Enter your mobile number to receive sms text alerts.

Email Address *

Address *

Address Line 2

City *

State *

Zip *

Disability and Onset Date*

Adaptive Equipment / Accommodations Needed*

Allergens & Reactions (mild, moderate, severe, life threatening)*

EMERGENCY INFORMATION

Emergency Contact*

Emergency Contact Phone 1*

Emergency Contact Phone 2

Emergency Medical Conditions*

Seizures, bee allergy, diabetes, etc

Epinephrine Pen*

If yes, independent with use

VETERANS ONLY

Please complete if you are a veteran of the Armed Forces.

Dates of Service

Branch of Service

Rank at time of separation

Disability Rating

If rating from VA is pending or if still active duty please state that above

Join our mailing list

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

3.1 Alaska Warriors Hockey Participant Information Form

Who will be participating?

Signee Information

EMERGENCY INFORMATION

VETERANS ONLY

Please enter participants' full names: