ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION

Size: px
Start display at page:

Download "ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION"

Transcription

1 ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION Player Information First Name: Last Name: Address: City, State, Zip: Home Phone: Date Of Birth: School: Grade: Jersey Size: Age Division Select a division below: 6U (6 and Under as of January 1, 2018) 8U (7 or 8 as of January 1, 2018) 10U (9 or 10 as of January 1, 2018) 12U (11 or 12 as of January 1, 2018) 17U (13-17 as of January 1, 2018) Players that wish to play above or below their normal age division must be approved by the ESO Board of Directors. You will be notified if there are any issues with your desired age division. Playing Experience Years of Softball Playing Experience: It is helpful to identify the experienced pitchers and catchers before the season, to help determine how many teams we can field in each division. Please check below if your child is an experienced pitcher and/or catcher. Experienced Pitcher Experienced Catcher

2 ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION Medical Information Allergies or Special Needs: Emergency Contact Name: Phone #: Relation: Parent/Guardian 1 First Name: Last Name: Address: Home Phone: Work Phone: Cell Phone: Relationship to Player: Parent/Guardian 2 First Name: Last Name: Address: Home Phone: Work Phone: Cell Phone: Relationship to Player:

3 ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION Fees The ESO Fall Season registration fee breaks down as follows: 6U 8U and Older Before June 30, 2017 $99 + $75 volunteer deposit $185 + $75 volunteer deposit June 30, 2017 to August 19, 2017 $109 + $75 volunteer deposit $199 + $75 volunteer deposit After August 19, 2017 $114 + $75 volunteer deposit $224 + $75 volunteer deposit Each family is required to volunteer four (4) hours at ESO per registered player during the season. A $75 deposit (noted in the table above) is added to each family's registration fee and will be refunded once the family has completed their required volunteer hours. You may choose to pay a non-refundable $50 volunteer buy-out instead of the $75 volunteer deposit. Signature I understand that my daughter s registration will not be complete unless I return the following: A check payable to ESO Girls Softball for the appropriate amount indicated under the Fees section of this packet. A signed ESO Release and Waiver of Liability. A signed ESO Registration Policy. A signed ESO Code of Conduct. I have read and understand all of the information on this form. All information entered is correct and up-to-date. Please mail the documents in this packet to: Encino-Sherman Oaks Girls Softball P.O. Box Encino, CA 91416

4 ESO Release and Waiver of Liability IN CONSIDERATION of my child being allowed to participate in activities and events offered by the San Fernando Valley Girls Softball Association, Inc. doing business as Encino Sherman Oaks Girls Softball (hereinafter ESO ), including the activities and events of the various teams both inside and outside of the ESO, through December 31, 2017, and on behalf of myself, and my personal representatives, heirs, children, attorneys, successors, and assigns, for myself and on behalf of my participating child: 1. HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE ESO or any of its teams, managers, coaches, players, participants, officials, members of its Board of Directors, committee members, facility owners and lessees, sponsors, advertisers, volunteers, employees, agents, and all persons assisting in the conduct of ESO activities or events, (all of whom are herein collectively referred to as the RELEASEES ), FROM ALL LIABILITY FOR ANY AND ALL PRESENT OR FUTURE LOSS OR DAMAGE, AND ANY CLAIMS, DEMANDS, AND CAUSES OF ACTION (hereinafter LIABILITY ) ON ACCOUNT OF ANY PERSONAL OR OTHER INJURY, INCLUDING RESULTING IN DEATH, OR PROPERTY DAMAGE, ARISING OUT OF OR RELATED TO ANY ESO EVENT OR OTHER ACTIVITY; and from any cause whatsoever, including, without limitation, the failure of anyone to enforce rules and regulations, to make inspections, the condition of any portion of the facilities or premises, defective products, any act or omission of the RELEASEES, or any other act WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. This release, waiver, discharge, and covenant not to sue also expressly covers all LIABILITY in any way related to my presence, or the presence of my participating child or any other child, for any reason at the facilities of ESO or on the premises where the ESO events and/or activities take place, including as a spectator, and includes transportation to and from the activities and events. This release, waiver, discharge, and covenant not to sue also expressly covers all LIABILITY for personal injuries sustained as a result of NEGLIGENT RESCUE OPERATIONS OR PROCEDURES. 2. HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them FROM ANY LOSSES, DAMAGES, INJURIES, DEBTS, LIABILITIES, EXPENSES (including actual court costs and attorneys fees), JUDGMENTS, OR COSTS they may incur due to claims, demands, damages or causes of action brought against the RELEASEES on account of any injury, including but not limited to, death or damage to property, caused or alleged to be caused in whole or in part by the negligence RELEASEES or otherwise arising from or related in any way to any ESO event or activity. 3. If despite this release, I, my child, or anyone acting on my or my child s behalf makes a claim against any of the RELEASEES, I AGREE TO INDEMNIFY, AND SAVE AND HOLD HARMLESS THE RELEASEES, and each of them, from ANY LITIGATION EXPENSES, ATTORNEYS FEES, LOSS, LIABILITY, DAMAGE, OR COST THEY MAY INCUR DUE TO THE CLAIM MADE AGAINST ANY OF THE RELEASEES, WHETHER THE CLAIM IS BASED ON THE NEGLIGENCE of the RELEASEES or otherwise arising from or related in any way to any ESO event or activity. 4. HEREBY AGREE THAT THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT extends to all acts of negligence by the RELEASEES and is intended to be as broad and inclusive as is permitted by the laws of the State and that if any portion of this agreement is held to be invalid or overly broad, the entire agreement will not be invalidated; rather, the agreement will be deemed modified so as to be applied to the fullest extent permitted by applicable law. 5. I sign this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT on my own behalf and on behalf of my child. By my signature below, I warrant that I am the parent or legal guardian of the participating child as designated on the corresponding Little League Registration and Application, and that I am legally authorized to sign this agreement on behalf of the participating child.

5 6. THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT shall be binding as to my child or any child within my care, whether signed by one parent or both parents, and shall also be binding as to each signing parent. I AFFIRM THAT I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, INCLUDING THE RIGHTS OF MY PARTICIPATING CHILD, AND I HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME, AND I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I further agree that no oral representations, statements or inducements, apart from the foregoing written agreement, have been made.

6 Registration Period ESO Registration Policy Registration will be open until we reach league capacity or the designated deadline. At that time, a waiting list will begin. Players on the waiting list will be contacted if an opening occurs. Late registrations are subject to availability. Player Evaluations Registration fees are due at the time of enrollment. ESO requires all players in the 8U to 17U divisions to attend a skills assessment. For more information, see the Player Evaluations page on our website. Refund Policy There is a $25.00 non-refundable processing fee on all applicants who withdraw from ESO prior to the player draft. After the player draft, no refunds will be issued. ESO will not carry fees forward to the next season if a player withdraws from the current season. Discounts Early bird discounts and other expiring discounts are only applicable up to the expiration date. You must pay your registration fees in full prior to the expiration date to be eligible for the discount. You must agree to these policies before completing your registration and submitting payment to the league. Volunteer Fee The $75 volunteer deposit will be refunded after your family works four (4) hours in the snack bar, or possibly in other league volunteer activities. Time spent assistant coaching or as a team parent is not applied toward the 4-hour volunteer deposit requirement. Signature I have read and understand the ESO Registration Policy:

7 ESO Code of Conduct In an effort to encourage a child-friendly, positive, supportive environment in sports, ESO Girls Fastpitch Softball has mandated the following Code of Conduct for its managers, coaches and parents to agree to. No manager, coach, player or spectator shall, at any time: 1. Lay a hand upon, push, shove, strike, or threaten to strike a league official, umpire, child or spectator; 2. Engage in ANY verbal or physical abuse upon any league official, umpire, child or spectator for any real or imaginary belief of a wrong decision or judgment or for ANY REASON WHATSOEVER; 3. Refuse to obey a request from the manager to leave the field or dugout; 4. Use profane, obscene or vulgar language in any manner at any time on the field of play, stands, or anywhere where the ESO Team is assembled (at any time and under any circumstances); 5. Possess or consume alcoholic beverages on the field of play, stands, or anywhere before, during or after a ESO practice or game under any circumstances; 6. Smoke (including e-cigarettes or similar) while in the stands or on the playing field or in any dugout. Smoking is not permitted anywhere on the Encino Franklin Field complex at any time. 7. Make derogatory, abusive, or disrespectful remarks to anyone, including, but not limited to, coaches, players, umpires, league officials or spectators at any time during an ESO practice or game. Signature I affirm that I have read the Code of Conduct and hereby promise to abide by its mandated rules and regulations. I understand that violating this Code of Conduct may result in disciplinary action by the ESO Board of Directors, including suspension and expulsion from the league.

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone: Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player

More information

Lake Washington Rowing Club

Lake Washington Rowing Club Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate

More information

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree: WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially

More information

Release of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING.

Release of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING. Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy

More information

Membership Registration Form

Membership Registration Form Today s Date: Leeward Judo Club Membership Registration Form Primary Dojo Location (Check box): Pearl City Waipahu Student Information: Name (First, MI, Last) Date of Birth Age Sex Male Female Address

More information

Hamilton and Friends Musical Theatre Camp

Hamilton and Friends Musical Theatre Camp JULY 9-20 SUMMER of 18! (Ages 9-13) Registration Form: $375.00/wk Early Bird Rate (now - March 1) $400.00/wk Standard Rate (beginning March 2) Child s Name: Date of Birth: Age: School Grade in the Fall:

More information

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team

More information

Volunteer Application

Volunteer Application Memorial and Museum 62 Battleship Place Camden, New Jersey 08103 Volunteer Application Name: Address:. Telephone: Home ( ) Cell ( ) Email: Area(s) of Interest: Referred by: Please complete the attached

More information

FLAGSTAFF FAMILY YMCA AFTER SCHOOL ADVENTURES

FLAGSTAFF FAMILY YMCA AFTER SCHOOL ADVENTURES FLAGSTAFF FAMILY YMCA 2018-2019 AFTER SCHOOL ADVENTURES Child s name Birth date Grade Age Parent s name Birth date (Required for registration) Address City AZ Zip code Home # Work # Cell# Parent s E-mail

More information

ADULT COACHING APPLICATION

ADULT COACHING APPLICATION - MIAMI ROWING & WATERSPORTS CENTER, Inc. ADULT COACHING APPLICATION -MEMBER HRLY Private lessons where non-members and members can come and row in a one-on-one session tailored to your skill level and

More information

Instructions for Completing Ford DSFL Waivers

Instructions for Completing Ford DSFL Waivers Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly

More information

Karen McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant:

Karen McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant: Volunteer- Counselor in Training Applications Spring 2018 Dear Counselor in Training Applicant: Boardman Park Adventure Day Camp Program prides itself on its reputation for quality and service. This recognition

More information

St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01)

St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01) St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01) Please make checks payable to St. Cloud Rugby Steelhead Player Full Name: Shorts Size needed (circle one, shorts are men s sizes): Small

More information

MEMBERSHIP CATEGORY (circle one) For current dues please refer to the website Membership page

MEMBERSHIP CATEGORY (circle one) For current dues please refer to the website Membership page Page 1 MEMBERSHIP REGISTRATION RAT ISLAND ROWING AND SCULLING CLUB NAME (print clearly): Date of birth: / / Home phone: ( ) - - Work/Cell: ( ) - - Email: Mailing address (city/ state) (Zip) Today s date:

More information

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of

More information

ASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT

ASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT -ALLTRYOUTSAT URBAN YOUTH ACADEMY 2801S.Vi ct orydr. ;Hous t on,tx 77088 PREREGI STER ONLI NEAT: ASTROS. COM/ UYA FOR OFFICE USE ONLY DIVISION: SOFTBALL JUNIOR SENIOR TRYOUT NO. ASTROS RBI FORMS CHECKLIST

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information

Ogden Cycle Association Membership Agreement

Ogden Cycle Association Membership Agreement Date: Ogden Cycle Association Membership Agreement Membership Type: (mark all that apply) Single Family Non-Wor king Charter Life Cash / Check # Amount Paid $ Receipt # New Member / Annual Renewal I agree

More information

5-STAR ACADEMY OF PERFORMING ARTS Student Registration Packet- WINTER 2019

5-STAR ACADEMY OF PERFORMING ARTS Student Registration Packet- WINTER 2019 5-STAR ACADEMY OF PERFORMING ARTS Student Registration Packet- WINTER 2019 STUDENT NAME: BIRTH DATE: GENDER: _ ADDRESS: PARENT NAME: PARENT EMAIL: PARENT PHONE NUMBER: PARENT WORK NUMBER: SECONDARY CONTACT

More information

RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT

RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT Available with permission from YMCA Services Corporation Copyright 2005 YMCA Services Corporation All Rights Reserved

More information

ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE

ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE DATE: JUNE 22 & 23, 2019 OCTOBER 5 & 6, 2019 LOCATION: THE MARKET COMMONS TIME: JUNE SATURDAY 11 AM 8 PM / SUNDAY 11 PM 7

More information

2016 5K Reindeer Run/Walk Team Registration

2016 5K Reindeer Run/Walk Team Registration 2016 5K Reindeer Run/Walk Team Registration Team Registration Forms and Waiver must be fully completed and received by December 2 nd in order to receive the $20/person group rate; Minimum of 3 people per

More information

Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers)

Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) (Commercial Activity Providers) WAIVER AND RELEASE OF LIABILITY

More information

Upper Natoma Rowing Club Junior Member Application (Please print clearly)

Upper Natoma Rowing Club Junior Member Application (Please print clearly) Upper Natoma Rowing Club Junior Member Application (Please print clearly) Name Birth Date Address City State Zip Code Phone Numbers (Home) Athlete (Cell) Athlete E-mail address School Graduation Year USRA

More information

POTOMAC VALLEY AAU REGISTRATION INFORMATION

POTOMAC VALLEY AAU REGISTRATION INFORMATION POTOMAC VALLEY AAU REGISTRATION INFORMATION Please ensure ALL documents are completed as indicated and placed in a large 9x12 envelope. Note: Rules requiring Government issued ID are in effect. Do not

More information

MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM

MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM Camp Information Address: City, State, Zip Code: Gender: Medical Information The decision whether to permit the participant identified

More information

Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child

Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Registration Form Please fill out and return to the address below

More information

SCCA Rally/Solo Release and Waiver Guidelines

SCCA Rally/Solo Release and Waiver Guidelines RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA

More information

DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT

DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT 1 Name (First, Last): Date of Birth: Gender: Email: Address: City: State: Zip Code: Phone (Home): Cell: Work: Place of Employment/School: Emergency Contact: Phone:

More information

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration

More information

Terms and Conditions for 5aside.org

Terms and Conditions for 5aside.org Terms and Conditions for 5aside.org For more information on any of the below, please contact info@5aside.org League and playing rules are available separately through our website. Definitions These definitions

More information

East Lake Girls Lacrosse 2018 Spring Registration Form. Waiver and Release Form:

East Lake Girls Lacrosse 2018 Spring Registration Form. Waiver and Release Form: East Lake Girls Lacrosse 2018 Spring Registration Form Name: Parent Name: Emergency Number: Email: Address: City: ZIP: Phone Number: Grade: Age: Birth date: School: Position: Shirt Size Short Size Registration

More information

MAKE WELLSTON BEAUTIFUL, INC

MAKE WELLSTON BEAUTIFUL, INC MAKE WELLSTON BEAUTIFUL, INC Parks and Recreation Programs REGISTRATION FORM Please submit this form along with your completed Emergency/Release Form and Registration Fee. Make checks payable to Make Wellston

More information

Presents the Prairie Days Parade

Presents the Prairie Days Parade Presents the Prairie Days Parade Saturday June 23, 2018 @ 9:30am Line up by 8:00am ~ Judging @ 9:00am Theme: Mail application to: Yelm Area Chamber of Commerce, PO Box 444, Yelm, WA 98597 or email to info@yelmchamber.com----application

More information

Pryme Tyme Before & After School Program Enrollment Form

Pryme Tyme Before & After School Program Enrollment Form Enrollment Form Child s Name Sex DOB / / Age Child s School Grade AM PM Both Lunch Status: E-Mail Mother s Name Cell #: Home #: Place of Employment: Work Phone: Employer s Full Address: Father s Name Cell

More information

Information about membership -

Information about membership - MEMBERSHIP INFORMATION 2018 We are excited about ST. CROIX JOAD and the opportunities that will present themselves to youth archers ages 8-20. ST. CROIX JOAD is one of only a handful USA ARCHERY JOAD clubs

More information

Pocock Rowing Center

Pocock Rowing Center Pocock Rowing Center Office Use QB LGL XL S Code Membership Forms New Member Existing Member Former Member First Name: Last Name: Address: City: St: Zip: Email Address: Cell Phone ( ) Alt Phone: ( ) Gender:

More information

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / / ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $ 300 in Cash and Prizes Saturday, March 24 th 2018 www.denvernorthsidett.com or 303-601-3415 Participant

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2016.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information

U.S. GOLD GYMNASTICS & CHEER ACADEMY INC.

U.S. GOLD GYMNASTICS & CHEER ACADEMY INC. RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ( AGREEMENT ) In consideration of participating in all activities at U.S. Gold Gymnastics and Cheer Academy, Inc., I represent

More information

For more information please refer to Board Policy #AP Sep-16

For more information please refer to Board Policy #AP Sep-16 WHEN DO I NEED TO DO A FIELD TRIP REQUEST? CLUB/ORGANIZATION FIELD TRIP ACADEMIC FIELD TRIP Copies of clubs approved field trip request, Emergency Information Form, RCCD Student Excursion Contract, and

More information

Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly

Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly Last Name: Parent s Name: Address: City: State: Zip Code: Home Phone: Cell Phone: E-mail address: Work Phone:

More information

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education 2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students

More information

South Suburban Youth Rugby Club

South Suburban Youth Rugby Club South Suburban Youth Rugby Club Middle School Grades 4-8 High School Fresh-Soph & Varsity Registration for 2016 Spring Season ALL FORMS MUST BE COMPLETED AND TURNED IN AND DUES PAID IN FULL BEFORE A PLAYER

More information

*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein.

*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein. AHSEP Enrollment Information Hobie Wave 14 Sailing Classes Youth: Thursdays July 27 & August 3 5:30 8:30 Adults: Saturdays July 29 & August 12 1:30-4:30 The 2017 Hobie Wave 14 Sailing Classes will be a

More information

Cheer Tumbling Registration Form. (Please complete all fields and understand all information stated below) Student Information

Cheer Tumbling Registration Form. (Please complete all fields and understand all information stated below) Student Information Signature of Parent/or Legal Guardian Cheer Tumbling Registration Form (Please complete all fields and understand all information stated below) How did you hear about us? Referral Name: Student Information

More information

Form Generic Liability Waiver. Legal Disclaimer

Form Generic Liability Waiver. Legal Disclaimer Form Generic Liability Waiver Developed by Ashley Newhall * and Kathleen Tabor Legal Disclaimer Attached is a generic liability waiver. This waiver is for educational purposes only! Using this form does

More information

MEMBERSHIP APPLICATION

MEMBERSHIP APPLICATION MEMBERSHIP APPLICATION How did you hear about the Y? Which facilities/programs do you plan to use? MEMBERSHIP TYPE YOU ARE SEEKING of Application Type of Membership PRIMARY MEMBER CONTACT INFORMATION Name

More information

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete When: Saturday, December 9. 2017 Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete Instructors: SU Coaches & current SU Athletes Schedule: 9:00-9:45 Registration 9:45

More information

*** ALL handlers/riders/drivers MUST complete this form *** CONDITIONS OF ENTRY AHSA LIABILITY DECLARATION EVERY HANDLER, RIDER, DRIVER, GROOM & ANYONE HANDLING A HORSE OR PONY MUST COMPLETE THE ARABIAN

More information

Tennessee Wesleyan University Volleyball Skills Camps

Tennessee Wesleyan University Volleyball Skills Camps Tennessee Wesleyan University Volleyball Skills Camps s: June 2 and June 9, 2018 at James L. Robb Gymnasium (204 E College St, Athens, TN 37303) (1:00pm-6:00pm, check in begins at 12:30pm) Cost: $75 per

More information

2003 AAU JUNIOR OLYMPIC GAMES DanceSport and Salsa ENTRY INSTRUCTIONS

2003 AAU JUNIOR OLYMPIC GAMES DanceSport and Salsa ENTRY INSTRUCTIONS 2003 AAU JUNIOR OLYMPIC GAMES DanceSport and Salsa INDIVIDUAL ATHLETE ENTRY FORM ENTRY INSTRUCTIONS ENTRY DEADLINE: Received by Tuesday, July 1, 2003. Late entries will not be accepted. Guaranteed overnight

More information

Athlete C hecklist. Step 1: Step 2: Step 3: Step 4: CONTACT INFORMATION:

Athlete C hecklist. Step 1: Step 2: Step 3: Step 4: CONTACT INFORMATION: Athlete C hecklist Step 1: Complete the ATHLETE REGISTRATION forms including: ATHLETE INFORMATION ATHLETE RELEASE & WAIVER OF LIABILITY & ACCIDENT AGREEMENT PAYMENT AGREEMENT Step 2: Return forms with

More information

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / / 2018 Denver NorthSide TTC FALL CLASSIC TOURNAMENT ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $500.00 in Cash and Trophies Saturday, October 13 th,

More information

YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form

YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form PARTICIPANT INFORMATION: YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form Child (1) Name: Sex: [M] [F] (circle one) of birth: / / Camp Type/Location: YMCA Day Camp (Pre-K - 5 th ) Downtown YMCA

More information

2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS

2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS 2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions

More information

2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS

2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions

More information

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY PUEBLO RANGERS Individual Waiver Soccer Club PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY (MUST BE COMPLETED AND PRESENTED AT LEAST 30 MINUTES PRIOR TO YOUR FIRST

More information

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF. Dear Race Director, Thank you for your interest in using the USECF event coverage for your event. Enclosed you will find USECF insurance information for the 2017 year which can be used for gravel grinders,

More information

DIVE IN! Speed Demons Swim Team. Fulton Family YMCA 715 W. Broadway Fulton, NY Phone:

DIVE IN! Speed Demons Swim Team. Fulton Family YMCA 715 W. Broadway Fulton, NY Phone: DIVE IN! 2018-2019 Speed Demons Swim Team Fulton Family YMCA 715 W. Broadway Fulton, NY 13069 Phone: 315-598-9622 www.fultonfamilyymca.org 2018-2019 Fulton Speed Demons Registration Participant Name: Date:

More information

APPLICATION FOR THE ADOPT-A-STREET PROGRAM

APPLICATION FOR THE ADOPT-A-STREET PROGRAM APPLICATION FOR THE ADOPT-A-STREET PROGRAM Group Name (Applicant): Contact Person: E-Mail Address: Address: Phone Number: Street Name and Limits: I,, acting as or for the above named Applicant, acknowledge

More information

PRINTING INSTRUCTIONS

PRINTING INSTRUCTIONS PRINTING INSTRUCTIONS All forms must be printed in COLOR on standard 8.5 x 11 paper. Black and white or illegible copies will NOT be accepted. 1. The MINOR VEST APPLICATION is a one (1) page form. 2. The

More information

1. MMDS Inc. will conduct an instructional driving program (Program) for, (Students name).

1. MMDS Inc. will conduct an instructional driving program (Program) for, (Students name). THIS AGREEMENT is entered into on the day of 20, by and between Max Maxwell Motorsports & Driving School, Inc. (hereafter referred to as "MMDS Inc. ) And (Parents Name) (Hereafter referred to as Parent

More information

MIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For:

MIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For: MIAMI ROWING & WATERSPORTS CENTER, INC. 2017 Membership (6 pages) Application For: FAMILY MEMBERSHIP: Initiation Fee: $500.00 Monthly Dues: $110.00 Annual Due $1320.00 Equipment Fund Monthly Due $15.00

More information

Camper Information Camper Name: Age: DOB: Address: City: State: Zip: Parent Information Parent/Guardian Name: Home Phone: Cell: Parent s

Camper Information Camper Name: Age: DOB: Address: City: State: Zip: Parent Information Parent/Guardian Name: Home Phone: Cell: Parent s 9744 St. Vincent Ave. Shreveport, La. 71106 Summer Day Camp 2018 Registration Packet We are delighted you have chosen to consider our fun camps this summer! We are looking forward to another great and

More information

Agreement and Release of Liability

Agreement and Release of Liability Agreement and Release of Liability MARTIAL ARTS TRAINING / WRESTLING AND FITNESS TRAINING ARE INHERENTLY DANGEROUS AND PHYSICALLY DEMANDING. IF YOU HAVE EXISTING MEDICAL CONDITIONS, BACK PROBLEMS, A HEART

More information

EWAUNA ROWING CLUB, INC

EWAUNA ROWING CLUB, INC EWAUNA ROWING CLUB, INC MEMBERSHIP INFORMATION/INSTRUCTION FORM CLUB DUES/PAYMENT SCHEDULE: Annual dues are effective for the calendar year (January 1 st through December 31 st). A single payment in the

More information

2012 LWRC Dues and Storage Fees

2012 LWRC Dues and Storage Fees 2012 LWRC Dues and Storage Fees Annual Membership Dues Regular Membership - $710.00 ($648.40 plus 9.5% tax) Family Membership $1065.00 ($972.60 plus 9.5% tax) Staff Membership for coaches & coxswains.

More information

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics.

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. Name/: Date & Day of Event: Start Time: End Time: *see page 2 for set times available

More information

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer: Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,

More information

ALL DRIVERS MUST COMPLETE INFORMATION BELOW

ALL DRIVERS MUST COMPLETE INFORMATION BELOW Mailing Address: PO Box 322 Lancaster, NY 14086 Phone: 716-759-6818 Website: LancasterNationalSpeedway.com 2018 STOCK CAR REGISTRATION, MEMBERSHIP & NUMBER APPLICATION PLEASE PRINT LEGIBLY ALL DRIVERS

More information

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m. PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release

More information

Emergency Medical Release & Liability Waiver

Emergency Medical Release & Liability Waiver Emergency Medical Release & Liability Waiver Participant s Name Birthdate Street Address City Zip EMERGENCY INFORMATION Father's Name Home Phone ( ) Cell/Bus Phone ( ) Mother's Name Home Phone ( ) Cell/Bus

More information

Shining Stars Afterschool Program

Shining Stars Afterschool Program Shining Stars Afterschool Program Monday-Friday 3:45-7:15 pm $40 per week/1st child $30 per week/2nd child *$36 for 3-Day Drop-In *Each Child* Games Crafts Movies Sports Homework Assistance Daily Snack

More information

OBSERVED HOLIDAYS No classes

OBSERVED HOLIDAYS No classes 1 114 E Oak Ave Visalia, CA 93291 (559) 627-8277 spacpp@att.net www.spacdance.com @WeTrainDancers Student Enrollment form Please fill out for each student Student Name (First) (Last) Address (Town) (Zip)

More information

Individual waiver Form: Master form included, makes copies as needed. Athletes should sign only where indicated (at ATHELTE S SIGNATURE line).

Individual waiver Form: Master form included, makes copies as needed. Athletes should sign only where indicated (at ATHELTE S SIGNATURE line). POTOMAC VALLEY REGISTRATION CHECK LIST Please double check to make certain that the following documents have been completed as indicated: Rules requiring Government issued ID is in effect. Registration

More information

After School Program Registration Form

After School Program Registration Form 2018-19 After School Program Registration Form Office Use Only Date registered: _ Staff: Please fill out this form entirely. If there are blanks it may slow down your child s enrollment process. If a line

More information

Requirements for Volunteer Club Coaches

Requirements for Volunteer Club Coaches University of California, Irvine Campus Recreation CLUB SPORTS COACH AGREEMENT THE FOLLOWING ITEMS MUST BE COMPLETED TO BECOME AN APPROVED VOLUNTEER CLUB COACH. Requirements for Volunteer Club Coaches

More information

THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX

THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX Saturday February 26, 2011 Lyman Elementary School 2032 N. Kansas Ave. Topeka, Kansas 9:00AM to Noon! All races are Finals (with Flights as needed) Events for

More information

Release. I, do hereby:

Release. I, do hereby: , Release I, do hereby: 1. Release waive discharge and covenant not to sue Turning Point Farms, Inc. and/or Theresa Petyo, Amanda Swendseid, their operators, horse owners, investors, and each of them,

More information

Please note that there is no liability coverage for wrestling activities held at a home or residential dwelling

Please note that there is no liability coverage for wrestling activities held at a home or residential dwelling Insurance coverage 2017-18 Insurance Information At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and

More information

TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM

TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM 2017-2018 Teen First Name Last Name Please select the program(s) that you are wanting to register for the 2017-2018 school year and include your deposit(s)

More information

After School Program Registration Form

After School Program Registration Form To enroll your child in the Duncanville Fieldhouse AFSP Program, please complete the information below and return to the Fieldhouse Front desk along with payment and a completed registration packet. CHILD

More information

WRAP/YMCA Expanded Learning Program

WRAP/YMCA Expanded Learning Program 2018-2019 School Year School: Child s Last Name: First Name: Sex: M F Birth date: / / Age: Home Phone: ( ) Home Address: Cell Phone: ( ) City: State: Zip: Child lives with: Mom Dad Both Parents Other Begin

More information

Saturday, April 22, 2017

Saturday, April 22, 2017 Saturday, April 22, 2017 Maximum 90 shooters allowed - Pre-Registration Required. Deadline for entries is Friday April 9, 2017. No Refunds after April 9 th. EVERY YOUTH SHOOTER GETS A LUNCH!!!!! Location:

More information

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet:

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet: Nights of Lights Youth Opti Regatta ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, 2018 Skipper s Name: DOB: Age: Boat/Fleet: Club: Sail Number: Coach Name: Coach Phone: MUST CHECK

More information

Only officials who have turned in the completed availability packet by the deadline date will be invited to attend the Mandatory Officials Meeting.

Only officials who have turned in the completed availability packet by the deadline date will be invited to attend the Mandatory Officials Meeting. V A L L E Y M U N I C I P A L S P O R T S O F F I C E 6911 Laurelgrove Avenue North Hollywood, California 91605 Phone: (818) 756-8073 Fax: (818) 764-5794 E-mail: basketball.munisports@rap.lacity.org DATE:

More information

Before and After School Care

Before and After School Care Before and After School Care BLAIR FAMILY YMCA 2016-2017 School Year Registration Forms To put Christian principles into practice through programs that build a health spirit, mind and body for all. -YMCA

More information

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start

More information

Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver

Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Stark Museum of Art Application for Summer 2018 Art Quest Program, Health Form/Consent, and Liability Waiver Camp Sessions Listed on Page 2 Application Due June 22, 2018 Application must be complete in

More information

Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church

Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church th Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church Session II: June 12th - June 16th, Performance June 13th; Music On Wheels Academy Music Camp

More information

22nd Annual Go Shibata Memorial & Brown Belt Championships Texas Judo Inc All Star Event

22nd Annual Go Shibata Memorial & Brown Belt Championships Texas Judo Inc All Star Event HOST: Judo Team DATE: LOCATION: SANCTION: WEIGH-IN: Physical Education Activity Building (PEAP) 632 Penberthy Road College Station, Texas 77843 USA Judo Sanction pending Weigh-in and Registration at the

More information

B.A.M. Brevard Attitude Modification

B.A.M. Brevard Attitude Modification PLEASE PRINT Minor s Name: Age: Grade Entering: Date of Birth: Gender: (Male or Female) Address: City: Zip: Home Phone: Parent/Guardian Name: Place of Employment: Work Phone: Driver s License Number: Cell

More information

WAIVER 2019 DEL MAR JUNIOR LIFEGUARD / LITTLE TURTLE / XTENDED PROGRAM

WAIVER 2019 DEL MAR JUNIOR LIFEGUARD / LITTLE TURTLE / XTENDED PROGRAM WAIVER 2019 DEL MAR JUNIOR LIFEGUARD / LITTLE TURTLE / XTENDED PROGRAM NOTE There are 5 pages of waiver forms, 4 need signatures, check the back of print outs! DUE DATE On or before June 1 st, 2019 INSTRUCTIONS

More information

2013 USACA MEMBERSHIP & INSURANCE

2013 USACA MEMBERSHIP & INSURANCE 2013 USACA MEMBERSHIP & INSURANCE USACA Membership and Insurance Dues for 2013 Membership and Insurance rates for 2013 will remain the same as 2012 rates Membership and Insurance (general liability and

More information

Please fill out both sides of this form!!!

Please fill out both sides of this form!!! $ # Circle one: Mixed Doubles Rockbridge Hunt Hunter Pace & Trail Ride Please fill out both sides of this form!!! Entry fee: Adult rider (18 and over) -- $35 per horse Junior rider (under 18) -- $20 per

More information

ATLANTIC COUNTY GOVERNMENT Division of Human Resources 1333 Atlantic Avenue, Atlantic City, NJ

ATLANTIC COUNTY GOVERNMENT Division of Human Resources 1333 Atlantic Avenue, Atlantic City, NJ (PLEASE PRINT OR TYPE) ATLANTIC COUNTY GOVERNMENT Division of Human Resources 1333 Atlantic Avenue, Atlantic City, NJ 08401 www.aclink.org VOLUNTEER/INTERN/SPECIAL APPLICATION PERSONAL DATA NAME LAST FIRST

More information

INSURANCE INFORMATION

INSURANCE INFORMATION These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

More information

2018 Jr. Celtics School Vacation Week Two Day Clinic Registration Packet

2018 Jr. Celtics School Vacation Week Two Day Clinic Registration Packet 2018 Jr. Celtics School Vacation Week Two Day Clinic Registration Packet For more information call 617-399-8432 or email Sam at: jrceltics@celtics.com When: Monday, February 19, 2018 & Tuesday, February

More information

STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT

STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT I,, desire to participate voluntarily in the Study Abroad Program, West Texas A&M University, described

More information