Philadelphia Gators Semi-Pro Football Organization

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Philadelphia Gators Semi-Pro Football Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Position:

* Age:

* Weight:

* Height: Ft: Inches::

* Pants size::

* Jersey Size::

* Football Experience:

* High School:(Please list all accomplishments, awards, and statistics):

* College/University:(Please list all accomplishments, awards, and statistics):

* Semi-Pro/Professional Experience::

* Team Name/League::

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

I acknowledge that this Accident Waiver and Liability Form will be used by the event holders, The Philadelphia Gators and all organizers of the activities or events in which I may participate, and that it will govern my actions and responsibilities at any said activities or events.

In consideration of my application and permitting me to participate in this event, I hereby take action for my executors, administrators, heirs, next of kin, successors, and assigns as follows:

X _____________________________________________________

I certify that I am physically fit, have sufficiently prepared or trained for participation in the activities or events and have not been advised to not participate by a qualified medical professional. I certify that there are no health related reasons or problems which preclude my participation in any activities and events.

(B) I ____________________________ Indemnify, Hold Harmless, and Promise Not To Sue the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in any activities and/or events, whether caused by the negligence of release or otherwise.

I acknowledge that this activity or event may involve a test of person’s physical and mental limits and my carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic and actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to the participants, but are also present for volunteers.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

X__________________________________________________________

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during any and all activities and events.

I understand that at this event or related activities, I may be photographed. I agree to allow my photo or film likeness to be used for any legitimate purpose by the Philadelphia Gators, event holders, producers, sponsors, and organizers.

The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable laws.

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN ALL PHILADELPHIA GATORS TRIPS, PRACTICES, EVENTS AND OTHER ORGANIZATIONAL ACTIVITIES, including by the way example and not limitation, any risks that may arise from negligence or carelessness on the part of persons, entities being released, from dangerous or defective equipment or property owned, maintained, or controlled them, or because of their possible liability without fault.

(A) I ____________________________ Waive, Release, and Discharge from any and all liability, including but not limited to, liability arising from the negligence or fault to the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my travel to and from said events, The Following Entities or Persons: officers, volunteers, representatives and agents.

I/we agree with the above *

Signature:

Date:

Signature:

Date:

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Philadelphia Gators Semi-Pro Football Registration Form