Recreation Services Adult Sports Roster

Recreation Services Adult Sports Roster
Team Name:*
Sport:*
Season/Year:*

Roster:*

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OFFICIAL USE ONLY: DATE RECEIVED: blank STAFF:blank

CITY OF PRESCOTT RECREATION SERVICES DEPARTMENT: ACCIDENT WAIVER AND RELEASE OF LIABILITY
I acknowledge that this recreational activity may be an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, DISEASE AND INFECTION, conditions of equipment, vehicular traffic, water conditions, 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.

I hereby assume all the risks of participating in this event.

I certify that I am physically fit, have sufficiently trained for participation in this event at the level of my registration and have not been advised otherwise by a qualified medical person.

I acknowledge that the City of Prescott and the event holders, sponsors and organizers, will use this Accident Waiver and Release of Liability (AWRL) form and it will govern my actions and responsibilities at said events.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, the following entities or persons: The City of Prescott and their directors, officers, employees, volunteers, representatives and agents, the event holders, event sponsors, event directors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities or alleged to be caused in whole or in part by the negligence of the City or its employees or agents or otherwise.

I hereby consent to receive and assume responsibility for all costs related to any medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this event.

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

This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
MANAGER/COACH:

All players must complete all information and sign the roster before they participate in a game. Any player under 18 years of age must have a parent or guardian complete the separate accident waiver and release of liability form available at the Recreation Services Office. Please have every player read the accident waiver and release of liability information before signing the roster on the reverse side. This original form will be kept in the Recreation Services Office. Should you so desire a copy, you may stop by the office located at 824 E. Gurley St. and pick one up from 8am-5pm on weekdays.
Team Name:*
Sport:*
Season/Year:*
Division:*
Men's, Women's, Coed...
Level of Play:*
Day(s)/Night(s) of Play:*
Manager/Coach Name:*

First NameLast Name
Manager/Coach Phone Number:*
Please enter a valid phone number.
Manager/Coach Email:
example@example.com
Manager/Coach Signature*

Clear
I hereby acknowledge that the following information is correct and that I am responsible for presenting this information to the field/gym supervisor of the program listed below. As the team manager/coach, I verify that the players' names, addresses and phone numbers have been signed by each individual player and players have had the opportunity to read this document.
Today's Date*

MonthDayYear
Date
Should be Empty:

Recreation Services Adult Sports Roster

CITY OF PRESCOTT RECREATION SERVICES DEPARTMENT: ACCIDENT WAIVER AND RELEASE OF LIABILITY

MANAGER/COACH: