Mail all completed forms (in mass) to:
|
|
|
- Edwin Daniel
- 5 years ago
- Views:
Transcription
1 INSTRUCTIONS FORD FIELD LIABILITY WAIVER FORMS Ford Field requires two waiver forms: WAIVER OF LIABILITY a form for minors AGREEMENT AND RELEASE OF ALL CLAIMS a form for adults DIRECTIONS FOR FILLING OUT AND SUBMITTING THE AGREEMENT FORMS! A fully executed form must be submitted for each person in your organization that will be stepping onto the field at Ford Field.! File only one form per person either an adult form or a student form.! Only persons of legal age (18) should fill out these forms! A person of legal age (18) must witness the form! A person CANNOT be his or her own witness.! The forms must be completed in INK and not be altered in any way. Include with all of your completed forms a completed Band Director's Certification of Waivers form, and your Band s Roster (listing ALL names of students and adults in ALPHABETICAL ORDER. Be sure the forms and your roster of names are both in the SAME ORDER (alphabetically). You may submit two separate rosters: one for students, and one for adults. Be sure and include YOURSELF. Mail all completed forms (in mass) to: MCBA North Seymour Rd. Montrose, MI DEADLINE FOR SUBMISSION: RECEIVED BY 10/20/18
2 FORD FIELD WAIVER OF LIABILITY It is understood that participation in the Michigan Competing Band Competition (the Event ) November 3, 2018 (Date) has inherent dangers. In consideration for the opportunity of Jack Spratt, a minor (the Minor ), to participate in the Event, I (we) the undersigned parent(s) or guardian of the Minor, hereby expressly release and forever discharge, on behalf of the Minor, the undersigned and their family, heirs, assigns and personal representative, all participating groups and other persons, including Ford Field Management, LLC, Ford Field Condominium Association, Ford Field Management Company, Ford Field Enterprises, DLI Properties, LLC, DLI Properties, Inc., DLI Management, Inc., DLI Parking, LLC, DLI Office Realty, LLC, DLI Entertainment, LLC, DLI Parking Realty, LLC, The Detroit Lions, Inc., Detroit Lions Charities, Detroit Lions Properties, FFP Investment Company, LLC, S.A.F.E. Management, LLC, City of Detroit, Downtown Detroit Development Authority, Detroit/Wayne County Stadium Authority, Wayne County, and their respective officers, directors, board members, employees, councilpersons, contractors, and agents (collectively, the Released Parties ) from any and all claims, damages and costs arising from or related in any way to the Minor s participation in the Event and/or the Released Parties negligence, including, without limitation, any bodily and personal injuries, however caused. The undersigned understands that the Event is intended for all those in good physical health and that those with serious health conditions (such as heart problems, physical ailments, arthritis, etc.) are advised not to participate in the Event. By signing this Waiver of Liability ( Waiver ), the undersigned represents that the Minor has no serious health problems and that the Minor can safely participate in the Event. The undersigned further understands and agrees that the undersigned is responsible for supervising the Minor during the Minor s participation in the Event. The undersigned agrees not to sue any of the Released Parties for any matter released under this Waiver and to pay the Released Parties attorneys fees and costs resulting from a breach of this Waiver by the undersigned. The undersigned further agrees that if anyone else, including the Minor, sues any of the Released Parties related to Minor s participation in the Event, the undersigned will indemnify and hold harmless the Released Parties against all damages, costs and their attorneys fees. The undersigned expressly agrees that this Waiver is intended to be as broad and inclusive as is permitted by law. If any portion is held invalid, the balance shall continue in full force and effect. WITNESSED BY: PARENT(S) OR GUARDIAN (Adult) Beverly Hiller Josephine Spratt Martin Spratt DA DATE: Revised 02/14/2012 Detroit_ _1
3 AGREEMENT AND RELEASE OF ALL CLAIMS In consideration of the granting of permission to participate in activities being conducted in or adjacent to the premises known as Ford Field, located at the intersection of Brush Street and Adams Avenue in Detroit, Michigan ( Ford Field ), for the purpose of: Michigan Competing Band Competition November 3, 2018, the undersigned, being of lawful age, and for his/her heirs, personal representatives, assigns and anyone claiming through him/her, releases and forever discharges all participating groups and other persons, including Ford Field Management, LLC, Ford Field Condominium Association, Ford Field Management Company, Ford Field Enterprises, DLI Properties, LLC, DLI Properties, Inc., DLI Management, Inc., DLI Parking, LLC, DLI Office Realty, LLC, DLI Entertainment, LLC, DLI Parking Realty, LLC, The Detroit Lions, Inc., Detroit Lions Charities, Detroit Lions Properties, FFP Investment Company, LLC, S.A.F.E. Management, LLC, City of Detroit, Downtown Detroit Development Authority, Detroit/Wayne County Stadium Authority, Wayne County and their respective officers, directors, board members, employees, councilpersons, contractors, and agents (collectively, the Released Parties ), from any and all claims, damages and costs, now existing or hereafter arising, known or unknown, related in any way to the undersigned s entry upon the premises of Ford Field and/or the Released Parties negligence, including, without limitation, any bodily and personal injuries and/or property damage, however caused, to the fullest extent of the law. The undersigned agrees not to sue any of the Released Parties for any matter released under this Agreement and Release of All Claims ( Agreement ) and to pay the Released Parties attorneys fees and costs resulting from a breach of this Agreement by the undersigned. The undersigned agrees that if anyone else sues any of the Released Parties related to actions of the undersigned while on the premises at Ford Field, the undersigned will indemnify and hold harmless the Released Parties against all damages, costs and their attorneys fees. The undersigned further agrees that (a) no promise, inducement or agreement not herein expressed has been made to the undersigned; (b) this Agreement contains the entire agreement between the parties hereto; (c) this Agreement may not be modified, except in a written instrument signed by an authorized representative of the Released Parties; and (d) if any portion of this Agreement is held invalid, the balance shall continue in full force and effect.. WITNESS READ THIS AGREEMENT AND RELEASE OF ALL CLAIMS BEFORE SIGNING. John Doe Christopher Robin Sign name ( the undersigned ) Christopher Robin Print name Date Detroit_ _1
4 FORD FIELD WAIVER OF LIABILITY It is understood that participation in the Michigan Competing Band Competition (the Event ) November 3, 2018 (Date) has inherent dangers. In consideration for the opportunity of, a minor (the Minor ), to participate in the Event, I (we) the undersigned parent(s) or guardian of the Minor, hereby expressly release and forever discharge, on behalf of the Minor, the undersigned and their family, heirs, assigns and personal representative, all participating groups and other persons, including Ford Field Management, LLC, Ford Field Condominium Association, Ford Field Management Company, Ford Field Enterprises, DLI Properties, LLC, DLI Properties, Inc., DLI Management, Inc., DLI Parking, LLC, DLI Office Realty, LLC, DLI Entertainment, LLC, DLI Parking Realty, LLC, The Detroit Lions, Inc., Detroit Lions Charities, Detroit Lions Properties, FFP Investment Company, LLC, S.A.F.E. Management, LLC, City of Detroit, Downtown Detroit Development Authority, Detroit/Wayne County Stadium Authority, Wayne County, and their respective officers, directors, board members, employees, councilpersons, contractors, and agents (collectively, the Released Parties ) from any and all claims, damages and costs arising from or related in any way to the Minor s participation in the Event and/or the Released Parties negligence, including, without limitation, any bodily and personal injuries, however caused. The undersigned understands that the Event is intended for all those in good physical health and that those with serious health conditions (such as heart problems, physical ailments, arthritis, etc.) are advised not to participate in the Event. By signing this Waiver of Liability ( Waiver ), the undersigned represents that the Minor has no serious health problems and that the Minor can safely participate in the Event. The undersigned further understands and agrees that the undersigned is responsible for supervising the Minor during the Minor s participation in the Event. The undersigned agrees not to sue any of the Released Parties for any matter released under this Waiver and to pay the Released Parties attorneys fees and costs resulting from a breach of this Waiver by the undersigned. The undersigned further agrees that if anyone else, including the Minor, sues any of the Released Parties related to Minor s participation in the Event, the undersigned will indemnify and hold harmless the Released Parties against all damages, costs and their attorneys fees. The undersigned expressly agrees that this Waiver is intended to be as broad and inclusive as is permitted by law. If any portion is held invalid, the balance shall continue in full force and effect. WITNESSED BY: PARENT(S) OR GUARDIAN (Adult) DATE: DATE: Revised 02/14/2012 Detroit_ _1
5 AGREEMENT AND RELEASE OF ALL CLAIMS In consideration of the granting of permission to participate in activities being conducted in or adjacent to the premises known as Ford Field, located at the intersection of Brush Street and Adams Avenue in Detroit, Michigan ( Ford Field ), for the purpose of: Michigan Competing Band Competition November 3, 2018, the undersigned, being of lawful age, and for his/her heirs, personal representatives, assigns and anyone claiming through him/her, releases and forever discharges all participating groups and other persons, including Ford Field Management, LLC, Ford Field Condominium Association, Ford Field Management Company, Ford Field Enterprises, DLI Properties, LLC, DLI Properties, Inc., DLI Management, Inc., DLI Parking, LLC, DLI Office Realty, LLC, DLI Entertainment, LLC, DLI Parking Realty, LLC, The Detroit Lions, Inc., Detroit Lions Charities, Detroit Lions Properties, FFP Investment Company, LLC, S.A.F.E. Management, LLC, City of Detroit, Downtown Detroit Development Authority, Detroit/Wayne County Stadium Authority, Wayne County and their respective officers, directors, board members, employees, councilpersons, contractors, and agents (collectively, the Released Parties ), from any and all claims, damages and costs, now existing or hereafter arising, known or unknown, related in any way to the undersigned s entry upon the premises of Ford Field and/or the Released Parties negligence, including, without limitation, any bodily and personal injuries and/or property damage, however caused, to the fullest extent of the law. The undersigned agrees not to sue any of the Released Parties for any matter released under this Agreement and Release of All Claims ( Agreement ) and to pay the Released Parties attorneys fees and costs resulting from a breach of this Agreement by the undersigned. The undersigned agrees that if anyone else sues any of the Released Parties related to actions of the undersigned while on the premises at Ford Field, the undersigned will indemnify and hold harmless the Released Parties against all damages, costs and their attorneys fees. The undersigned further agrees that (a) no promise, inducement or agreement not herein expressed has been made to the undersigned; (b) this Agreement contains the entire agreement between the parties hereto; (c) this Agreement may not be modified, except in a written instrument signed by an authorized representative of the Released Parties; and (d) if any portion of this Agreement is held invalid, the balance shall continue in full force and effect.. WITNESS READ THIS AGREEMENT AND RELEASE OF ALL CLAIMS BEFORE SIGNING. Sign name ( the undersigned ) Print name Date Detroit_ _1
6 MICHIGAN COMPETING BAND ASSOCIATION FORD FIELD WAIVER OF LIABILITY FORM 2018 CHAMPIONSHIP CONTEST Ford Field - Detroit Band Director s Certification I,, Director of Bands, Name of Director, Name of High School do hereby certify that the enclosed ROSTER and AGREEMENT AND RELEASE OF ALL CLAIMS for the November 3, 2018, Michigan Competing Band Association Championship Contest represent EACH and EVERY person stepping onto the field for the Band s performance at Ford Field. Name of High School X Director s Signature Date Signed: DIRECTIONS FOR FILLING OUT AND SUBMITTING THE AGREEMENT FORMS Forms must be completed in ink. Only persons of legal age (18) should fill out the liability waiver forms. Forms submitted with this certification include every person in your organization that will be going onto the field at Ford Field. A person of legal age (18) must witness the form. A person CANNOT be his or her own witness. Include this form with your Band s Roster (showing ALL names of students and adults in ALPHABETICAL ORDER and signed waivers from each and every person that will be stepping onto the field at Ford Field. Be sure the AGREEMENT FORMS and your roster of names are both in the SAME ORDER (alphabetical). You may submit two rosters: one for students, and one for adults. Mail all completed forms to: MCBA North Seymour Rd. Montrose, MI DEADLINE FOR SUBMISSION: RECEIVED BY 10/ 0/18. Do not submit this form without all of your fully executed student and adult waiver forms.
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
PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE
WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely
WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely 1. Name: First Last M.I. 2. Email: 2. Mailing Address:
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,
SKATEBOARD COMPETITION ENTRY FORM
CITY OF KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES SKATEBOARD COMPETITION ENTRY FORM For your convenience, competition entry forms will be accepted in person, by mail, via fax or email at the location
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
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
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
St. Augustine Amphitheatre Farmer s Market. Vendor Application Instructions
St. Augustine Amphitheatre Farmer s Market Vendor Application Instructions To be considered for participation in the St. Augustine Amphitheatre Farmer s Market, please submit: - Completed and signed Vendor
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
(Student Last name, First name Middle Initial).
2013-14 (Student Last name, First name Middle Initial). Consent for Field Trip (P1a) DHS Band Combined Form P1a, P1b, P1c I hereby consent for the above named student to participate in athletic team, band,
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
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
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
WAIVER AND ASSUMPTION OF RISK AGREEMENT
WAIVER AND ASSUMPTION OF RISK AGREEMENT Information Note This Note does not form part of the Waiver and Assumption of Risk Agreement. It is intended to give guidance about what you are agreeing to by signing
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
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
Corynna s Wish. Application for Corynna s Wish. Here Are the Requests We Are Unable to Grant. Eligibility Requirements for Recipients
Corynna s Wish Corynna s Wish is a nonprofit granting entity that is dedicated to fulfilling wishes that patients and their families cannot accomplish either physically or financially. The organization
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,
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
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
License Agreement for Special Use of Park Facilities
Page 1 of 4 5045 Stanley Road Flint, Michigan 48506 800-648-PARK or 810-736-7100 GeneseeCountyParks.org License Agreement for Special Use of Park Facilities The hereby agrees to license the following facilities
InnoWorks 2017 Student Application Information and Instructions
InnoWorks 2017 Student Application Information and Instructions Welcome to the 2017 InnoWorks Workshop Student Application! Since 2003, InnoWorks has successfully conducted 50+ summer workshops, serving
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
ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT Participant s Name: Age: Date of Birth : (M) (D) (Y) Address: City: Province:
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
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
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
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
CITY KIDS DAY CAMP REGISTRATION FORM
RETURN CAMP ENTRY FORM WITH PAYMENT TO: M.C. PARKS 100 E. MICHIGAN BLVD. SUITE 2 MICHIGAN CITY, IN 46360 (219) 873-1506 www.michigancityparks.com CITY KIDS DAY CAMP REGISTRATION FORM 1. HOUSEHOLD 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: 1. I acknowledge that motor vehicle activity is a potentially
2016 OUCI Chinese Bridge Summer Camp Application
STUDENT INFORMATION Name (as it appears on your passport) Passport # Passport Expiration Date DOB Gender Cell Phone Email Address City State Zip PARENT/GUARDIAN INFORMATION Parent Phone Email Parent Phone
Can-Am X-Team Racer Support Program Application Form PLEASE PRINT CLEARLY. INCOMPLETE OR ILLEGIBLE FORMS WILL DELAY PROCESSING.
Supporting Dealer Identification BRP Dealer # : Dealership Name : Dealership Fax Number : Dealer Contact : Email : Phone number : Racer Identification You must have had some racing experience in the past
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,
Teller County Shooting Society (TCSS) P. O. Box 548; Woodland Park, CO Membership Application
Teller County Shooting Society (TCSS) www.tcss-co.org Application Instructions: Revised 25 January, 2019 1. Please fill in all the blanks on the application that apply. 2. Include your NRA membership number
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
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
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
INDEPENDENT CONTRACTOR/VENDOR AGREEMENT
INDEPENDENT CONTRACTOR/VENDOR AGREEMENT This Agreement, made on ( Effective Date ) by and between Owner Representative: HomeRiver Group (Hereinafter Owner s Representative ) and Contractor: (Hereinafter
Short Term Use of Facilities by Others
Short Term Use of Facilities by Others The following Short Term Facility Use Agreement ( Agreement ) or alternatively Short Term Facility Use Agreement Amendment ( Amendment ) or other approved agreement
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
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,
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
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
EQUIPMENT LENDING AGREEMENT
EQUIPMENT LENDING AGREEMENT The person signing this agreement and the organization on whose behalf the equipment lending is being made (collectively the Borrower ) are responsible for compliance with this
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
Youth Services Programs Application Please complete and return application to Nome Eskimo Community at 200 W. 5 th Avenue or Fax
P.O. Box 1090 Nome, Alaska 99762 Phone: (907) 443-2246 Fax: (907) 443-3539 www.necalaska.org Programs Application Please complete and return application to Nome Eskimo Community at 200 W. 5 th Avenue or
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
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:
SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM
SUMMER CAMP ACKNOWLEDGEMENT OF RISK FORM I,, am the parent and/or legal guardian of, a minor child under the age of 18 years. I would like to have my child participate in the following CAMP/PROGRAM at
Event Registration Form
Event Registration Form Event and Date: Rider s Name: Rider s Address: Rider s Cell Phone: Rider s Age: Horse s Name: What level is your horse currently training: If you will be riding in the Fix-A-Test
Student Domestic Travel Instructions
Student Domestic Travel Instructions This information is provided to assist University Faculty and Staff members in planning and conducting classroom and/or co-curricular trips. Page 1. This page provides
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:
Release and Waiver of Liability. Release and Waiver of Liability for Adults Page 2 & 3. Release and Waiver of Liability for Minor Page 4 & 5
Release and Waiver of Liability Release and Waiver of Liability for Adults Page 2 & 3 Release and Waiver of Liability for Minor Page 4 & 5 1 Release and Waiver of Liability for Adults Adult - An adult
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
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:
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
WEB: eaglelakecamps.com. PHONE: 800-US-EAGLE ( ) (local) FAX:
WEB: eaglelakecamps.com PHONE: 800-US-EAGLE (873-2453) 719-272-7453 (local) FAX: 719-960-2558 MAIL: Eagle Lake Office P.O. Box 6819 Colorado Springs, CO 80934 RELEASE OF LIABILITY AND CONSENT TO MEDICAL
Colorado Trek Paper Work Check List
Colorado Trek Paper Work Check List Please make sure you have all your paperwork before sending it in Due June 2 - Paperwork Due June 2 - Full payment of $2400 NAME HATS Release Form Adventure Experience
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
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
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
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
Grand Island Central Catholic Shooting Team
Letter Program Requirements Signed Parental Consent Form. Signed Code of Conduct Form (Student & Parent / Guardian). Be enrolled At GICC during the time of participation. Follow & Live The "Code of Conduct".
INTERNSHIP APPLICATION
INTERNSHIP APPLICATION Personal / Academic Information: ID # Class Name First MI Last Major(s) CQPA MQPA E-mail Campus Box# Phone # Department of Internship Internship Title Start Date End Date Total Number
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
Welcome to the LeVerne Carlson Fitness Center!
Welcome to the LeVerne Carlson Fitness Center! Thank you for your interest in the LeVerne Carlson Fitness Center. This packet of information includes: membership rates, payment options, rules of the fitness
APPLICATION FOR PART TIME EMPLOYMENT
APPLICATION FOR PART TIME EMPLOYMENT Position: Desired Hourly Rate: Last Name First Name Date Address Street City State Zip Code Phone Number Email Address Are you at least 18 years of age or older? Yes
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
BITCAMP TERMS AND CODE OF CONDUCT BY PARTICIPATING IN BITCAMP, YOU AGREE TO THE FOLLOWING TERMS AND ALL OTHER APPLICABLE DOCUMENTS.
BITCAMP TERMS AND CODE OF CONDUCT BY PARTICIPATING IN BITCAMP, YOU AGREE TO THE FOLLOWING TERMS AND ALL OTHER APPLICABLE DOCUMENTS. Henceforth, "I", me, "my", myself, and other first-person pronouns shall
O*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017
O*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017 COACHED WORKOUTS for WINTER 2017 - We offer workouts overseen by experienced coaches. All adult
WILLOW POND STABLES, LLC 2240 S. River Road Saginaw, MI
WILLOW POND STABLES, LLC 2240 S. River Road Saginaw, MI 48609 989-781-7707 BOARDING CONTRACT AND LIABILITY RELEASE This BOARDING CONTRACT AND LIABILITY RELEASE ( Agreement ) is made between Willow Pond
31 st Annual Bluegrass Festival August 10 th 12 th, 2018
31 st Annual Bluegrass Festival August 10 th 12 th, 2018 Vendor Name: Contact: Cell #: Email: Retail Vendor Application & Agreement DUE April 6 th, 2018 Vendors applying for 2018 Bluegrass Fest will be
2018 REGISTRATION FORM - COMPLETED FORM WITH PAYMENT MUST BE RECEIVED BY THE CONTINUING EDUCATION DEPT. FOR STUDENT TO BE REGISTERED FOR CAMP.
Summer Camps 2018 Luzerne County Community College 1333 South Prospect Street, Nanticoke, PA 18634 Tel: 570-740-0495 Fax: 570-740-0491 www.luzerne.edu/coned 2018 REGISTRATION FORM - COMPLETED FORM WITH
EMERGENCY CONTACT INFORMATION. Name of person to contact in the event of an emergency;
BATTLE CREEK AREA HABITAT FOR HUMANITY WOMEN BUILD MAY 5, 9-12, 2018 (Battle Creek) MAY 17-19, 2018 (Marshall) VOLUNTEER APPLICATION (Please return via email, fax or mail) Name: (please print) Maiden Name:
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
Central Plains Dressage Society Dressage Schooling Show at Oklahoma State Fair State Fair Park, Oklahoma City OK
Central Plains Dressage Society Dressage Schooling Show at Oklahoma State Fair State Fair Park, Oklahoma City OK Featuring Dressage and Western Dressage Excellent facility and footing Monday, September
Tween and Teen Think It, Move It for Students with Social Challenges
Tween and Teen Think It, Move It for Students with Social Challenges This unique program will combine the introduction of social thinking concepts with motor development. Our tweens and teens will receive
SHOOTING STARS FILM CAMP Hay Street Fayetteville, NC
SHOOTING STARS FILM CAMP 2019 121 Hay Street Fayetteville, NC 28301 910.486.9036 Application 2019 Week 1 June 17-21 : COST: $250 Week 2 June 24-28 : TIME: 11:00a to 5:00p Drop-off 10:45a to 11:00a Pick-up
Parental or Guardian Permission and Medical Release Activity. Parental or Guardian Permission and Medical Release Activity
Parental or Guardian Permission and Medical Release Activity Ward Stake Participant of birth Home telephone number Participant s parent or guardian Business telephone number Address City State/Province
Westhollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability
Westhollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability In consideration of my use of Westhollow Village s swimming pools, I hereby forever
Adult 3-on-3 Basketball League 2018
Adult 3-on-3 Basketball League 2018 Welcome to s Adult 3-on-3 Basketball league. Seasons are either 8 or 10 weeks of play followed by play-offs (if you qualify). TEAM FEES/Per Season: $300 (8 Week Season)
The Clubs of Prestonwood Junior Golf Academy Summer Golf Camps 2016
The Clubs of Prestonwood Junior Golf Academy Summer Golf Camps 2016 Creek Course 9:00am 12:00pm / 4:00pm 2016 Golf Summer Academy Camp Sessions Session 1 June 7-10 Session 2 June 21-24 Session 3 July 5-8
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
2019 United States Snowshoe Association Event Sanctioning Application
2019 United States Snowshoe Association Event Sanctioning Application USSSA 5317 Thistlebrook Court Raleigh, NC 27610 518-420-6961 Application Must Be Submitted At Least 60 Days Prior to Event Thank you
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
Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT
Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado 81344 (970) 560-2926 No. LLAMA LEASE AGREEMENT Redwood Llama Company, LLC ( Lessor ) agrees to lease to the Customer named below
SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM
SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM Personal Information Child s Name Age of Birth Parent/Legal Guardian 1 Phone Parent/Legal Guardian 2 Phone Address Alternate Phone work cell other
Please complete the following paperwork and return it to us in one of the following ways:
Thank you for your interest in volunteering with us! We are GRATEFUL for every hour that every volunteer serves. Whether your interest is in seeing patients in our HOPE Program, assisting with administrative
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
ANNUAL LAKE ERIE OPEN WATER CLASSIC
Sunday, July 19, 2015 Sanction Number: EVENT INFORMATION EVENTS: There will be ½-Mile, 1-mile and 2-mile swims on a triangular course in Lake Erie. The start will be in the water. The finish will be on
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
2018 CYC Junior Rowing Summer Program Registration
2018 CYC Junior Rowing Summer Program Registration Rower s Last Name First Name Age/DOB Address City State Zip Code Email Cell School Grade Level (Fall 2018) Parent s Last Name First Name Address City
MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County
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
ACKNOWLEDGEMENT AND WAIVER REGARDING LIABILITY FOR ALTERATIONS
ACKNOWLEDGEMENT AND WAIVER REGARDING LIABILITY FOR ALTERATIONS WHEREAS: A. (the Owner ), of Unit, Strata Lot in Strata Plan (the Strata Lot ) wishes to carry out certain alterations or renovation to the
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 (Students Name) (Hereafter referred to as student
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
ANTEATER RECREATION SUMMER CAMP
ANTEATER RECREATION SUMMER CAMP COMPLETING YOUR WAIVER FORMS All forms have the ability to be completed through Adobe Acrobat. At this time, the University still requires inked (not electronic) signatures.
Subsidized after school slots requires participant to attend the after school program 5 days/week and stay until 5:30PM
Sunnyside Elementary After School Program Registration 2016-2017 School Year SECTION A: PROGRAM SITE AND SCHEDULE School: Sunnyside Elementary After School Program Monday Tuesday Wednesday Thursday Friday
ManHood Camp LA 2017 Registration Paperwork Instructions
ManHood Camp LA 2017 Registration Paperwork Instructions 1) Please print out the following paperwork for your group. 2) You will need a liability release signed for every person in your group, both youth