REGISTRATION FORM WAIVER. E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL):
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1 REGISTRATION FORM NAME: GENDER: E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL): MAILING ADDRESS: CITY: STATE: ZIP CODE: PRIMARY PHONE: EMERGENCY CONTACT NAME: DAY PHONE: DOCTORS NAME: ALTERNATE PHONE: RELATIONSHIP: NIGHT PHONE: PHONE: MEDICATIONS: ALLERGIES/MEDICAL CONDITIONS: WAIVER In consideration of the acceptance of my application to participate in the North Texas Senior Games I hereby, for myself, my heirs, executors, administrators, and assigns do hereby release, waive, and/or forever discharge any and all rights, claims, and causes of action for damages that may be suffered by me as the result of my preparation for and/or participation in the 2018 North Texas Senior Games. I recognize and voluntarily accept all risks associated with my participation in the event, no matter how remote or unlikely. I realize that my activity may well include serious bodily injury, catastrophic spinal injury (including total or partial paralysis), permanent impairment, brain damage, and even death. I recognize that these injuries may be sustained by me from falling, tripping, being pushed, running, striking, or being struck by a spectator, another participant, a vehicle, equipment used in the event, and the like. As an adult, I take full responsibility for my participation in this event and for the level at which I choose to participate. I have no impairment, physical or mental, that should preclude my participating in this event at the level that I choose. I am physically fit and capable of participating in this event at the level that I choose. I understand that I can remove myself from participating in this event at any time I choose to do so. I do not expect the Senior Sports Festival, its agents, volunteers, officers, employees, any partner cities, or sponsors to coach, manage, instruct, or train me for this event. I recognize that it is my personal responsibility to learn, prepare, understand, and obey the rules for this activity or event. Prior to participating as an athlete I will inspect the facilities and equipment to be used and if I believe some to be unsafe, I will immediately report such condition(s) to the Sport Commissioner, Supervisor, or Official connected with the Festival and either decline to participate or assume the risk of participating. The undersigned expressly agrees that the foregoing Waiver and Release of all claims is intended to be as broad and inclusive as is permitted by the laws of Texas and that if any portion thereof is held invalid it is agreed that the balance shall not withstanding, continue in full legal force and effect. I assume all of the above rusks and release, waive, discharge, hold harmless indemnify, and covenant not to sue North Texas Senior Games, Midwestern State University, North Texas Rehabilitation Center, Village Bowl, Weeks Park Golf Course, City of Wichita Falls and/or Wichita Falls Parks & Recreation, Wichita Falls Independent School District, any of the organizations board, employees, volunteers, coaches, trainers, officials, partner cities and sponsors, or others affiliated with the Festival. Further, I grant full permission to use my photograph, picture, likeness, and/or voice to appear in any official documentary, promotional (including any and all advertisements), television, radio, or film coverage of the North Texas 9
2 Senior Games without compensation. I consent to all emergency medical treatment as may be deemed appropriate under existing circumstances by medical personnel or personnel associated with the Festival. I, the undersigned, have carefully read and voluntarily signed this hold-harmless Waiver and Release of all claims and fully understand its contents and meaning as full waiver and release of all claims, liability, and indemnity for the Senior Sports Festival, its agents, volunteers, officers, employees, and any partner cities, and sponsors. Participant Signature Participant Name (print) Date Date North Texas Senior Games Photograph/Video Waiver As a participant in the North Texas Senior Games I give permission and consent to allow photographs and/or videos, to be taken of myself during the 2018 North Texas Senior Games to be held May 17 20, 2018 on the MSU campus and partner sites. I further give my permission and consent that any such photographs and videos may be published and used by Midwestern State University and/or North Texas Senior Games and its agents, to illustrate and promote the senior games experience and events. Signed Date 9
3 2018 NORTH TEXAS SENIOR GAMES ENTRY FORM City of Dallas Senior Games registration fee is $25 plus an additional cost per event after 2 nd event. Fees are per event, per person. Athletes must have a partner to enter doubles events. During registration, you must enter your partners name when asked, doubles will not be assigned. Each partner or team member must complete their own registration form. Age Category: Swimming $4 each o 50 BACKSTROKE o 100 BACKSTROKE o 200 BACKSTROKE o 50 BREASTSTROKE o 100 BREASTSTROKE o 200 BREASTSTROKE o 50 BUTTERFLY o 100 BUTTERFLY o 50 FREESTYLE o 100 FREESTYLE o 200 FREESTYLE o 500 FREESTYLE o 100 INDV MEDLEY o 200 INDV MEDLEY Table Tennis $4 each Golf $20 each o o Track & Field $4 each o 50M o 100M o 200M o 400M o 800M o 1500M o 1500M POWER WALK o DISCUS o SHOT PUT o HIGH JUMP o LONG JUMP o DISCUS o SHOT PUT o HIGH JUMP o LONG JUMP Billiards $4 each Dominoes $4 each o o o MIXED Horseshoes $4 each Forty-Two(42) $4 each o o o MIXED Washers $4 each 10
4 Basketball $4 each FREE THROW o o 3 ON 3 o o Bowling $4 each Cycling $4 each Tennis $4 each o 5K TIME TRIAL o 10K TIME TRIAL o ROAD RACE o 5K TIME TRIAL o 10K TIME TRIAL o ROAD RACE Pickleball $4 each Partner Name: PAYT INFORMATION Registration Fee = $25.00 Attending Opening Ceremony 11am) Additional Shirts = $ Attending Athlete Social 5:30pm) ($10 x # of shirts) Total Event Fees = $ Donation = $ TOTAL = $ Payment Information: Date Received: Payment Type: Cash Check Credit Card 10
5 10
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MEMBERSHIP APPLICATION WE RE MORE THAN A GYM WE RE A CAUSE YMCA of Broome County MEMBERSHIP RATES Membership Type Monthly Payment Annual Payment (automatic withdrawal) First payment will be pro-rated based
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
Name of Group: Reservation Date: Zip: Phone (w) (h) Departure Time Person in Charge: # Expected Ages
Dear Thank you for choosing the YMCA for your gathering. We are happy to have you and your group at our facility. Your group is scheduled to arrive on at. Enclosed you will find the Regulations for Use
Dance Competition Rules and Regulations
Dance Competition 2017-2018 Rules and Regulations Hmong Cultural New Year Celebration, Inc. Competition 2017-2018 will be held on December 27 through December 29. HCNYC Policy: all contestants pay the
Registration Form Trek Jordan 2019
Please return your completed, signed form to JCH along with your deposit in order to confirm your place on the trek. Trip: TREKS- Jordan Trip Date: 5 th -12 th October 2019 All information must be as per
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
Date of Birth Address City State Zip
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. You have the right to consult
2017/18 Out of School Program Registration Form
2017/18 Out of School Program Registration Form Child: First Name MI Last Name YMCA Member Non Member E-mail NOTE: There is a one time, non-refundable $20 registration fee per child required to secure
2017 Minor Crew Check-List
2017 Minor Crew Check-List Following you will find the necessary forms to complete your 2017 IMSA Membership/License application and Annual hard card application. This checklist is meant to assist you
First Name: Middle Initial: Last Name: Gender: D.O.B: / / Age: Years of YMCA Camp Participation: Address: Apt/Unit #:
Camp Location: Camper Grade 2017-18 School Year: Does your camper require any special needs identified through Section 504 (I.D.E.A or an I.E.P)? Yes No If yes, please explain: Camper Grade 2018-19 School