2022 MEMBERSHIP APPLICATION

General Information

In this section we need to identify the program applying for insurance. For instance, if you are a
Hockey School or other large operation, we would require the name of the Company operating the
programs. If you are a Spring Hockey Team, we would need the name of the team (or) the name of
the person on the Ice Rental Contract. We must also have a complete address including (street and
number – city – province – postal code. (PO boxes are not valid for insurance)

Company, Team, Contact Name:

Address (including city and postal code):

Main Contact:

E-Mail:

Phone:

Website (if Applicable):

SPRING/SUMMER MULTIPLE TOURNAMENT TEAMS

This section is for organizations that have multiple teams under the same name that are playing in
tournaments in the Spring/Summer. These teams are provided insurance January 1st each year until
August 31st each year.

Total Number of Teams:

Contact Teams:

Non-Contact Teams:

SPRING/SUMMER SINGLE TOURNAMENT TEAM

This section is for individual teams that are playing in tournaments in the Spring/Summer. These
teams are provided insurance January 1st each year until August 31st each year.

Contact Teams:

Non-Contact Teams:

Number of Tournaments (Estimate)

Number of Practices (Estimate)

HOCKEY SCHOOLS

This section is for weekly training where individuals or teams attend training where you have
rented the ice. In this area, please tell us an estimate number of days in the year that you offer
training. The number of players on average that attend each hour, and the number of unique
players that attend your training over the year. (if a player attends multiple session just count them
once)

Estimated Days of Training per year:

Estimated hours per year of Training:

Estimated number of players per hour:

Estimated number of Unique Players:

HOCKEY SCHOOLS REMOTE LOCATION TRAINING

This section is where you offer training for teams at a location rented by the team.

Estimated number of days of training per year

Total hours per year:

HOCKEY CAMPS – DAILY AND WEEKLY

This section is camps for players where you rented the ice. Please tell us how many unique players
will attend (estimate) the camps. If a player attends two camps count them only once.

Estimated number of single-day camps per year:

Estimated number of unique players per day:

Estimated number of weekly camps per year:

Estimated number of unique players per week:

HOCKEY LEAGUE – 3on3 – 4on4 – 5on5

In this section, we need to know how many teams you have playing in a league, and also the
number of players on the teams. We are not looking for every player who comes in and out as
affiliates, but the number of spots on a team when they play.

Number of Games in the League:

Number of Contact Teams:

Number of Non-Contact Teams:

Number of Players per Team:

League Start Date:

League End Date:

ARENA’S YOU RENT ICE FROM FOR YOUR PROGRAMS

NOTE: In this area we need to know what arena’s you are renting ice from for your practices,
tryouts, and exhibition games. The arena’s usually ask to be added to the certificate as additionally
insured.
Also ask the arena if the city or town needs to be listed as well, because this happens often.
We DO NOT need to know the arena’s that you are playing at for tournaments at as the operators
of the tournament handle that for insurance purposes.
If you are uncertain about which arena’s you might use, please list all arena’s you could use so we
reduce the number of changes we will have to make. If there is not enough space you send an
attachment of all the arenas.

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

Arena/City/Town Name in Full:

Address (including city and postal code):

SIGNATURE AND POSITION WITH COMPANY OR TEAM

Name Printed or Typed:

Position with the Company or Team:

Signature: I certify that I am legally able to sign on behalf of Company or Team, (if you do not have
a saved signature on your computer simply type your name here)

Date