; 20101009-PreseasonRoster-WaiverForm
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20101009-PreseasonRoster-WaiverForm

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  • pg 1
									                                   CITY OF MILFORD - RECREATION DEPARTMENT
                    OFFICIAL BASKETBALL, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT
  I, the undersigned parent/guardian acknowledge, agree, and understand that: Voluntarily and of my own free will, I elect to participate as a member of the
  I, the undersigned parent/guardian acknowledge, agree, and understand that: 1)1) Voluntarily and ofmy own free will, I elect to participate as a member of the
    softball team and league indicated below.       I I understand, that there are certain risks and hazards involved in participating in Basketball including, not
 Basketball team and league indicated below.2)2) understand, that there are certain risks and hazards involved in participating in Volleyball including, butbut not
      limited those hazards associated with weather conditions, playing conditions, equipment and other participants in in addition to acts of of throwing, and
 limited to to those hazards associated with weather conditions, playing conditions, equipment and other participantsaddition to thethe acts pitching, throwing,
 catching the ball, being ball, the swinging of the bat, running, jumping, stretching, sliding, diving, with other players and with stationary objects, all which can
courting and catching thehit with the ball, running, jumping, stretching, sliding, diving, and collisions and collisions with other players and with stationary objects,
  all which can injury or death to me death other and to Further, I agree that I agree that in for the right for member of the team of the team designated
 cause seriouscause serious injury or and to to me players.other players. Further,in considerationconsiderationas athe right as a memberdesignated below and in
 consideration for permission to play on the court on the court arranged for by the team I league: 1) I voluntarily elect solely assume all the risk of damage,
below and in consideration for permission to play arranged for by the team or league: 1)orvoluntarily elect or accept andor accept and solely assume all the risk
    damage, injury, including death, incurred or suffered while (a) while or playing as a member member of so team so designated, serving serving in a non-
of injury, including death, incurred or suffered by me (a)by me practicing practicing or playing as a of the team thedesignated, (b) while(b) whilein a non-playing
  capacity as a team team member or observer during practice of play or by other or by or by other players team, and (c) while while on or upon any of the
playing capacity as a member or observer during practice of play or by other teamsteams other players on myon my team, and (c) on or upon any and all and all
   courts arranged for by my team team or league for practice or 2) I release, discharge and and agree not to sue the team and/or league designated below or
  of the courts arranged for by my or league for practice or play. play. 2) I release, discharge agree not to sue the team and/or league designated below or any
        any lease or lease of the which basketball is played played or practiced by my team, the City of Milford, or their owners, officers, agents, associations,
owner orowner of the courts oncourts on which Volleyball isor practiced by my team, the City of Milford, or their owners, officers, agents, servants,servants,
employees, or any person or entity connected with the team, league, court, or the City of Milford, for any claim damages, costs or cause of action which I have
  associations, employees, or any person or entity connected with the team, league, court, the City of Milford, or the Amateur Volleyball Association of for any
or may in the future have as a result of injuries or damages sustained or incurred by me from whatever cause including but not limited to negligence, breach of
    claim damages, costs or cause of action which I have or may in the future have as a result of injuries or damages sustained or incurred by me from whatever
  contract or wrongful conduct of the partied hereby released. I further agree that I shall hold harmless and full indemnify the parties hereby released from any
  cause including but not limited to negligence, breach of contract or wrongful conduct of the partied hereby released. I further agree that I shall hold harmless
claims, damages, costs including attorney fees, and cause of any action which may arise from any claim or cause of action made by me, through me or on my
   behalf indemnify damages, injuries or death caused claims, or in part by any of the attorney entities hereby released. I ACKNOWLEDGE THAT I HAVE
 and full even if the the parties hereby released from anyin wholedamages, costs includingparties or fees, and cause of any action which may arise from any claim
         READ AND THAT I UNDERSTAND EACH AND EVERY ONE OF THE ABOVE PROVISIONS IN THIS WAIVER, RELEASE OF LIABILITY AND
      INDEMNIFICATION AGREEMENT AND AGREE TO ABIDE BY THEM. *PARTICIPANT (or PARENT/GUARDIAN IF UNDER 18) MUST INITIAL AFTER
                                                         SIGNATURE*

                                    DEVON ROTARY KNIGHTS PRESEASON BASKETBALL TOURNAMENT
                                                    Sponsored by Devon Rotary Knights Basketball League




                               TEAM NAME                                                                             Coach's Name

Division: Open _____                Recreational ______                                             Coach's Address (Street, City, State, Zip)
Circle One:
       U10 Boys         U12 Boys          U14 Boys                                                 Coach's Telephone - Home                 /    Work
        U10 Girls       U12 Girls         U14 Girls
                                                                                                                     Coach's Email
         PLAYER'S NAME                                                                                           BONAFIDE RESIDENCE
                                         PARENT'S SIGNATURE              INITIALS     DATE        D.O.B
        Please Print or Type                                                                                      Street, City State, Zip

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Team Manager' Affidavit: As the manager of this team, I certify that all information is complete and correct. I understand that if any information is found to be
false, incorrect, or fraudulent that I and/or my entire team will be subject to disqualification and disciplinary action. And, I am aware that as the manager/coach
I am responsible for the actions of all the members of my team and will abide by the rules and regulations as outlined.
Managers Signature:     ____________________________________                      Date:         ___________________________
                                                                           SPECIAL NOTES




                                                                         OFFICE USE ONLY
Date Received:______________        Fee ($200.00):_____________
         articipate as a member of the
       in Basketball including, but not
        the acts of pitching, throwing,
r players and with stationary objects,
with stationary objects, all which can
   he team designated below and in
    ly assume all the risk of damage,
   cept and solely assume all the risk
                                        -
              or on or upon any of the
          while upon any and all and all
         gue designated below or any
   rs, agents, servants, associations,
       or cause of action which I have
        imited to negligence, breach of
   parties hereby released from any
             y me, through me or on my
     which may arise from any claim

								
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