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2010 FALL LEAGUE SIGN-UP THE LEAGUE WILL START WITH PRACTICES THE WEEK OF JULY 26TH Practices and games will be at the JR STREETKINGS Arena in Hernando GAME TIMES: week nights and practice will vary COST: $100.00 per child before WHAT DO YOU GET? Each team will have one practice weekly, a ten game schedule, a guaranteed playoff spot, a team jersey, team photo and trophy. FORMAT: We will play by USA Inline Hockey rules. League will start in WITH PRACTICES THE WEEK OF JULY 26TH. Each game will consist of two halves. EQUIPMENT REQUIRED: Helmet w/cage,elbow pads, shin guards, gloves, roller blades and a stick. We will provide team jerseys and pucks. - We will need a volunteer coach for each team. - Also, if you or your business is interested in sponsoring a team Contact Derek Landmesser at 901-870-7825 or email at jrstreetkings@yahoo.com Or Danny Phillips at 901-262-2239 DPHIL10513@aol.com with any questions. ***Please make checks payable to Hernando Youth Sports*** NAME______________________________________________________________ ADDRESS______________________________________________________________DOB__________ AGE_____ HOME PHONE _______________________________________ CELL NUMBER _______________________________________ EMAIL ADDRESS__________________________________________________________________ RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT ("AGREEMENT") IN CONSIDERATION of being permitted to participate in any way in Jr. StreetKings league Activities ("Activity") I, for myself, my personal representatives, assigns, heirs and next of kin: 1. ACKNOWLEDGE, agree and represent that I understand the nature of Jr. StreetKings league Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. FULLY UNDERSTAND THAT: (a) Jr. StreetKings league ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these RISKS and dangers may be caused by my own actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity. 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the JR. STREETKINGS, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessees of premises on which Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIEGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, I or anyone on my behalf, makes a claim against and of the Releasees, from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. DATE: __________________________________________ PRINTED NAME OF PARTICIPANT: ____________________________________________________________________________ ADDRESS: ___________________________________________________________________________________________________ (Street) (City) (State) (Zip) --------------------------------------------------------------------------------------------------------------------------------------------------------------------- THIS PORTION MUST BE FILLED OUT BY A PARENT OR GUARDIAN IF PARTICIPANT IS UNDER 18 YEARS OF AGE AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF THE ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH TO THE RELEASEES FROM ALL LIABILITY, CLAIMS DEMANDS, LOSSES OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST ANY MAY OCCUR AS THE RESULT OF ANY SUCH CLAIM. PRINTED NAME OF PARENT/GUARDIAN: ___________________________________________________________________ SIGNATURE OF PARENTS / GUARDIAN: ____________________________________________________________________ PHONE NUMBER: __________________________________________________________________ CELL NUMBER: _______________________________________________________________ |