Citrus Heights
1st annual
Beer
Pong Tournament
Saturday
06/13/2009
at the Rocky’s
7440 club
Winning
team wins $250.00 cash
Sponsored by the
Citrus Heights Jr, Mavericks Youth Football
and Cheer
To register your team and
get a Registration packet please call 916-821-7101 or visit the Citrus Heights
Jr Mavericks website at www.chjrmavericks.com.you may also
pick up a packet at Rocky's 7440 club
Deadline for registration
is June 1st 2009
Thank
you for your continued support !!!
Citrus
Heights Beer Pong Tournament Registration
Team
Name :
___________________________________________________________
Player
One Name: ________________________________________________
Address:
________________________________________________________________
________________________________________________________________
Phone:
____________________________ Cell
Phone: ___________________
E- Mail ___________________________________________
Player
Two Name: ________________________________________________
Address:
________________________________________________________________
________________________________________________________________
Phone:
____________________________ Cell
Phone: ___________________
E- Mail
___________________________________________
Are
you representing a business ______YES
______NO
If
yes which one ________________________________________________________
Payment $50.00 enclosed by Money order Check Cash (make in person to get a receipt)
The
following must be completed:
· Registration
· Payment
· Liability Wavier
WAVIER AND RELEASE OF LIABILITY FORM
RELEASE OF LIABILITY, WAIVER OF CLAIMS,
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS,
INCLUDING THE RIGHT TO SUE
Citrus Heights Jr. Mavericks and all Sponsors involved.
1. 1. I agree to comply with all the rules, regulations, and event instructions of the Citrus Heights Jr. Mavericks Youth Football and Cheer here by known on this agreement waiver CHJM also all CHJM board members Representatives and agents.
2. I acknowledge that I have sole responsibility for my personal possessions during Tournaments, events, and related activities (hereinafter “events”) held or sponsored by CHJM.
3. I verify that I have no existing medical conditions that would prevent me from participating from events held or sponsored by the CHJM, and that I have consulted with a licensed physician regarding my physical ability to participate in events of CHJM prior to participating in said events of the CHJM
4. I consent to receiving medical treatment deemed advisable and/or necessary in the event of injury, accident or illness during an event held or sponsored by CHJM.
5. I permit the free use of my name and true and accurate pictures in promotional materials, broadcasts, telecasts and other forms of media as they pertain to CHJM.
6. I HEREBY RELEASE,
WAIVE, DISCHARGE AND COVENANT NOT TO SUE Any establishment, Or Person
involved with CHJM, OR its event committee, members, volunteers, employees,
sponsors, other participants, operators, officials, any persons in any
restricted area, advertisers, owners and lessees of premises used to conduct
the event and each of their officers, representatives, employees, and agents
(hereinafter “releasees”), from all liability to me, my personal
representatives, assigns, heirs, and next of kin for any and all loss or
damage, and any claim or demands therefore on account of injury to me or my
property or resulting in my death, whether caused by the negligence of the
releasees or otherwise while I am in or upon the competition floor area and/or
competing, officiating in, observing, working for, or for any purpose
participating in an event held or sponsored by CHJM.
7. I agree to indemnify, defend, and hold harmless the releasees from any loss, liability, damage or cost releasees may incur due to my presence in or upon the competition floor area or in any way competing, officiating, observing, working for, or for any purpose participating in an event held or sponsored by CHJM, and whether caused by the negligence of the releasees or otherwise.
8. I ASSUME FULL RESPONSIBILITY OF RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while in the competition floor area and/or while competing, officiating in, observing, working for, or for any purpose participating in an event held or sponsored by CHJM.
9. I AFFIRM THAT I WILL HAVE A DESIGNATED DRIVER, defined as any person 18 years of age or older not under the influence of any illicit substance, alcohol, or other product that would impair that person’s ability to properly operate a vehicle, TO TRANSPORT ME TO AND FROM ANY EVENTS HELD BY CHJM.
10. I WILL NOT OPERATE A MOTERIZED VEHICLE AFTER ANY EVENTS HELD BY CHJM IF I HAVE PARTICIPATED IN SAID EVENTS BY CONSUMING ALCOHOL.
I expressly acknowledge and agree that the activities could be dangerous and involve the risk of serious injury and/or death and/or property damage. I further expressly agree that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted, that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I HAVE READ AND VOLUNTARILY SIGN THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.
This waiver, release and indemnification agreement specifically embraces each and every
event sanctioned, authorized or promoted by said releases during the entire season or year of 2009 and applied to each and every event herein above mentioned, and has the same effect as if executed after each and every activity or event in which I participate so that the parties herein intended to be released and indemnified shall be fully and effectively released and indemnified as to each and every event herein above described.
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.
UNDERSTANDING OR RISK
I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.
X_____________________________ Date Signed:____________
(PARTICIPANT SIGNATURE)
______________________________________________
Participant name (Please print clearly)
________________________________________ ___________________________________
First Witness (signature) Second Witness (signature)
NAME AND ADDRESS (Print Clearly): NAME AND ADDRESS (Print Clearly):
________________________________ ________________________________
________________________________ ________________________________
________________________________ ________________________________
PLEASE READ CAREFULLY!