Recreational Roller Hockey Registration Form

Name:
Address:
City:
Zip:
Telephone: ( ) -
Age: Sex:   Male Female
Position:   Skater Goalie
Birthday: ,
E-mail Address:
   



Waiver of Liability, Release

Assumption of Risk & Indemnity Agreement

For and in consideration of participant’s registration with Sports Zone 2, Inc. Local association and member team (hereafter ASA) and being allowed to participate in ASA events and member team activities, the parent(s) or legal guardian(s) of participants relinquish any and all liability for and cause of action for personal injury, property damage or wrongful death occurring to participant arising out of participation in ASA events, member team activities, the sport of hockey, and/or activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant may have are hereby relinquished and the participant (or parent(s)/guardian(s)) does(do) so on behalf of my/our and participant’s heirs, executors, administrators and assigns.

Participant and/or participant’s parent(s)/guardian(s) acknowledge, understand and assume all risks inherent in hockey and any member team activities, and understand that said sport and activities involve risks to participant’s person including bodily injury, partial or total disability, paralysis, and death, and damages which may arise therefrom and that I/we have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the’releasees’ identified below. It is further acknowledged that there may be risks and dangers not known to us or are not reasonably foreseeable at this time.

Participant and/or participant’s parent(s)/guardian(s) acknowledge, understand and assume the risks, if any, arising from the conditions and use of hockey rinks and related premises and acknowledges and understands that included within the scope of this waiver and release is any cause of action, arising from the performance, or failure to perform maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said rinks, for negligent selection of certain releasees, or negligent supervision or instruction by releasees.

Participant or participant’s parent(s)/guardian(s) agree if any claim for participant’s personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever of wherever made or presented for participant’s personal injuries, property damage or wrongful death. It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death caused by negligence, including the negligence, if any, of releasees. ’Releasees’ include Sportszone 2, its Affiliate Associations, Local Associations, Member teams, event hosts, other participants, coaches, officials, sponsors, advertisers, owners and operators of the premises used to conduct any event and each of them, their officers, directors, agents and employees.

Participant and/or participant’s parent(s)/guardian(s) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers of hockey and understand these waivers and releases are necessary to allow amateur hockey to exist in its present form.

Yes   No    I have read, understood, and agreed to the terms above.

                             Date:

Yes   No    If under 18: I, the Parent and/or Legal Guardian, have read, understood, and agreed to the terms above and allow the above applicant to participate.

                             Date:


Emergency Notification Information:

Name:
Telephone: ( ) -

7716 Rutilio Ct. New Port Richey, FL 34653
Phone: 727-845-7808 Fax: 727-845-7918
E-mail: jim@sportszone2.com