Barnabas Athletic Association
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Barnabas Athletic Association
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Barnabas Athletic Association 2nd Annual Soccerthon Registration Form
Saturday August 4th, 2007
Check in will start promptly at 8:30am Games will start promptly at 9am and finish promptly at 7pm
Participant registration cost: $5.00 A minimum of $20.00 in Pledges to be paid day of event! (*Pledge forms are available at www.barnabasathletics.com)
Name:_______________________________________ Age:___________ Address: _____________________________________________________________ _____________________________________________________________ Phone #: _______________________ T-Shirt Size YM YL AS AM AL AXL AXXL *Children under the age of 10 need to be accompanied by an adult. *All participants must wear shin guards which will not be provided *Registration forms can be mailed to (must be post marked by July 14, 2007): Barnabas Athletic Association PO Box 1431 Cheektowaga, NY 14225
BAA use only: Paid: Cash _________ Check #_________ Received by: _____________________________ Date: ___________________ I represent that I am the custodial parent or legal guardian of the above child, who is participating in the Barnabas Athletic Association sports programs. In order that the child may participate in the program, I as the custodial parent/ legal guardian of this child freely and voluntarily sign this Waiver and Indemnification Agreement. I understand that there is inherent danger in participating in any athletic activity. I understand that by permitting my child to participate in this program, she/he may suffer or cause damage to or destruction of her property and or the property of others. I understand that physical injury could occur and may include permanent disabilities, paralysis, disfiguration or even death. I hereby waive, release and forever discharge any and all claims for any personal injury (including death), property damage or other loss, which I may have against Barnabas Athletic Association, its officers, directors, employees, or agents, or any other persons, corporations or entities connected with or participating in the sports programs here. Further, I agree to indemnify and hold harmless Barnabas Athletic Association, it’s officers, directors, employees or agents, or any other persons, corporations or entities connected with or participating in the sports programs from and against all claims, lawsuits, liabilities, losses, damages and expenses of every kind whatsoever resulting from any negligence, fault or lack of due care, or from any other cause whatsoever, which are related in any way to the child’s participation in the sports programs under Barnabas Athletic Association. This Waiver and Indemnification Agreement shall be binding upon my heir, executors, administrators, successors, and assigns. I have read this Waiver and Indemnification Agreement and fully understand its terms. I freely sign it and permit the child to participate in the sports programs at Barnabas Athletic Association.
Date_____________________ Signature of Custodial Parent or Legal Guardian_________________________________ ___ __ Cheektowaga, NY, USA *
You can either print this page, or download and print your registration form here.
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