MAKE WELLSTON BEAUTIFUL, INC

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Cecil Marsh
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MAKE WELLSTON BEAUTIFUL, INC Parks and Recreation Programs REGISTRATION FORM Please submit this form along with your completed Emergency/Release Form and Registration Fee.

1 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 Beautiful or MWB- P&R. Check the sport for which you are registering to play. If you are registering to play more than one sport, please indicate which sport is your primary sport. Soccer For soccer only rate your child s skill level from 1 to 5 (1 = novice, 5 = experienced): Volleyball Fall Baseball Fall Softball Registration fee for U14 Soccer (Grades 6th-8th) is $ Registration fee for all other Soccer, Volleyball, Fall Baseball and Fall Softball is $ A discount of $10.00 will apply for each additional child from the same immediate family, or if the same child is playing multiple sports. We believe that money should not be a barrier to participating in sports. If the registration fee creates a financial hardship for you, it may be waived. check here to have the registration fee waived check here if you wish to donate to cover fees for those who cannot afford the fees Player s Name (Last name, First Name): Date of Birth: Grade: Street Address: City/State/Zip: Parent/Guardian #1 Cell Phone: Home Phone: address:

2 Parent/Guardian #2 Cell Phone: Home Phone: address: UNIFORM SIZE INFORMATION: Shirt (All Sports listed!) YOUTH: S, M, L ADULT: S M L XL 2XL Sock Size (Soccer only!) YOUTH (3 to 6 yrs. old), INTERMEDIATE (7 to 10 yrs. old) & ADULT (11 yrs. old +) Short Size (U14 Soccer only!) YOUTH S, M, L Hat (Baseball only!) ADULT S, M, L, XL, 2XL YOUTH: S/M ADULT: L/XL Requested Jersey Number: Signature: (person who completed form must sign) ADMINISTRATIVE/OFFICE USE ONLY Paid w/ check. Check # Amount Paid w/ cash. Amount Initials of individual receiving payment

3 Head Coach or Assistant Coach Signup Form If interested in being a coach, provide your name and information below Name: Address: Home Phone: Cell Phone: Sport you wish to coach: Age group you wish to coach: Head Coach Assistant Coach Please note that all head coaches and assistant coaches will be required to complete a background check. This requirement will be waived if you have a background check on file with MWB that was completed within the past 24 months. Coaches will have the cost of their background check refunded.

4 D Make Wellston Beautiful, Inc. Parks & Recreation Programs Authorization for Medical Treatment And Waiver of Liability & Compensation for Minor Participants, Volunteers and Coaches I, the undersigned, hereby authorize and request a medical facility to administer all requested and/or indicated outpatient and surgical services to my child and/or myself (for volunteers and coaches) and when necessary, provide tetanus immunization or perform emergency procedures or refer to a duly licensed medical personnel for necessary emergency treatment when indicated, including transfer to outside hospitals. I further authorize and request any emergency medical service personnel to administer all requested and/or indicated treatment. The undersigned, as parent or guardian of the child (volunteer/coach if applicable) named above, desire that myself and/or child/ward participate in the above designated Make Wellston Beautiful, Project on Parks and Recreation programs and by execution of this release I agree that all requirements, directions and standards set by Make Wellston Beautiful, Inc. and coaching staff/personnel shall be deemed to have been accomplished for the benefit of my child/self. The undersigned further understands and agrees that their child and or self may be photographed or videotaped while participating in the Make Wellston Beautiful related events and activities, and that such images or video may be published in an outlet used to promote or publicize the sports program without compensation. For Players: In consideration of Make Wellston Beautiful Inc. s efforts on my child s behalf, I hereby voluntarily assume all risk of accident, injury, damage and/or loss to my child s property and self as well as compensation for use of my player s image including video without compensation which may arise out of my child s participation in the designated Make Wellston Beautiful, Inc. programs, hereby intending to release and discharge the City of Wellston, Make Wellston Beautiful, Inc., all employees and staff, agents, assigns, volunteers, and all personnel associated or connected with Make Wellston Beautiful, Inc. for every claim, liability or damage of any kind caused by negligence of the City of Wellston, Make Wellston Beautiful, Inc. and all personnel involved or which otherwise may result from participation in the designated programs. For Coaches and Volunteers: In consideration of Make Wellston Beautiful Inc. s efforts to promote good will in the community and for allowing my participation as a coach or volunteer in its programs, I hereby voluntarily assume all risk of accident, injury, damage and/or loss to my property and self as well as compensation for use of my image including video without compensation which may arise out of my participation in the designated Make Wellston Beautiful, Inc. programs, hereby intending to release and discharge the City of Wellston, Make Wellston Beautiful, Inc., all employees and staff, agents, assigns, volunteers, and all personnel associated or connected with Make Wellston Beautiful, Inc. for every claim, liability or damage of any kind caused by negligence of the City of Wellston, Make Wellston Beautiful, Inc. and all personnel involved or which otherwise may result from participation in the designated programs. Make Wellston Beautiful, Inc. does not provide insurance of any kind for volunteers, coaches or players. By signing this waiver and release, the signatory assumes all risk involved with coaching, volunteering and/or participating in the programs offered by Make Wellston Beautiful, Inc. I have read this release of liability and assumption of risk agreement, I fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. Signature of Parent or Guardian of Player: Date: Signature of Volunteer (if applicable) Date: Signature of Coach (if applicable) Date:

5 RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT In consideration of participating in the sport of volleyball, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence Make Wellston Beautiful, Inc. and its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as Releasees ), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows: 1. I acknowledge that the sport of volleyball involves known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, broken bones, torn ligaments, bruises, and other bodily injuries caused by contact with volleyballs, other participants, structures like nets and posts, or spectators or other obstacles outside the lines of the court, or caused by uneven playing surfaces; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity. 2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or. medical conditions, then I will immediately discontinue participation. 3. I hereby voluntary release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may be created, directly or indirectly, by any such condition. 5. In the event that I file a lawsuit, I agree to do so solely in the state where Releasees facility is located, and I further agree that the substantive law of that state shall apply. 6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence. I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated costs in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms. Signature Print Name Address City State Zip Telephone Date PARENT OR GUARDIAN ADDITIONAL AGREEMENT (Must be completed for participants under the age of 18) In consideration of (PRINT minor s names) being permitted to participate in this activity, I further agree to indemnify and hold harmless Releasees from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor. Parent or Guardian Print Date

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(847) 2017 Player/ Parent Tryout Information Sheet Thank you for attending Pi Volleyball spring club tryouts. Tryouts will conclude Monday, March 13th; within 1-48 hours of the tryouts conclusion, I will send