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New York City Table Hockey
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Cuozzo, Bob
Ellison, Jerome
Friedl, James
Galatioto, Bill
Galatioto, Nick
Handel, Victor
Marinoff, Lou
Mecca, Len
Owens, Roger
Poulianos, John
Power, Ed
Power, John
Sciacca, Anthony
Scoma, Greg
Struss, Kevin
Zawislak, Adam
NYCTHA Int'l Classic 2007 Tournament Stats
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PLAYER INFORMATION
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PARENT/GUARDIAN #1 (if you are under 18 years old)
Firstname:
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MEDICAL/EMERGENCY CONTACT INFORMATION
We ask that you fill-in the following information as you are comfortable, so we might assist you in the event of an emergency.
Emergency Contact:
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Policy #:
WAIVER INFORMATION
I, the undersigned, individually (or in the case of a minor, on behalf of the above-named entrant), acknowledge that the entrant will be using facilities at his/her own risk. I, on my own behalf, hereby release, discharge and indemnify the NYCTHA from all liabilities for damage, injury or illness to the entrant or his/her property during his/her participation in or travel to or from any NYCTHA event.
I/we agree with the above
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