TEAM NAME: ___________________________________________TEAM CITY: __________________________________

Manager’s name_____________________________________     email                                                                    

Address: ________________________________________________________ State _________ Zip Code___________

Manager home phone__________________________________    Manager Cell: __________________________

Assistant coach name_____________________________________    cell #_________________________________

Assistant Coach Name_____________________________________    cell #_________________________________

Age Group - Check One: _______ Middle School  ______High School ______ Adult  _____ Other:____________________

Fee is $150/team up to 12 members                                                                      All teams are Co-ed and must have 3 females on Court at all time

READ BEFORE SIGNING:   In consideration of being allowed to participate in any way in this league, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from the activities involved in the program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury do exist and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume all responsibility for my participation; and
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately, and
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Stone Bank Community Park and Recreation Club LLC, Stone Bank Youth Baseball,  Richie Clark Foundation,  Stone Bank School, and other officials of the League and its premises used to conduct the event (Releases), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

PARENTS / GUARDIANS SIGNATURE SHOULD BE ON THE SAME NUMBERED LINE AS PLAYER’S NAME APPEARS ON THIS ROSTER. By signing this roster, parent or legal guardian agrees to the above statements and verifies that the date of birth is correct. Parent or legal guardian o f each youth player must sign below. FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as parent / legal guardian with legal responsibility for this participant, do consent and agree to his / her release as provided above all the Releases, and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify the Releases from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

TEAM MANAGER/COACH AFFIDAVIT: I, the manager/coach of the above team, do hereby state that all of the information supplied above is correct to the best of my knowledge and that all parents or guardians signed the above in their own handwriting. I further agree that each player is eligible to compete with my team in the specific  events at Stone Bank Community Park during 2015.

MANAGER/COACH SIGNATURE ____________________________________________      Date ___________________________

IMPORTANT: Each team manager/coach shall be responsible to keep legal copies of birth certificates, etc., at all times in case of protest.