Stateline Sports Group Temporary Member Registration Form

DateTime

Your Name*

First NameLast Name

Players Name*

First NameLast Name

Email*

example@example.com

Mobil Phone*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I will be actively engaging in the Stateline Sports Group program in the following role:*

Substituting for a Stateline Fury TeamSubstituting for a Lady Shamrock TeamAttending a Program Practice and or a Training SessionUsing the Stateline Sports Group Indoor facility

Team I'm engaging with*

Date I'm Starting With*

Date

Date I'm Ending With*

Date

In consideration of being granted the opportunity to participate in the aforementioned event or activity, I hereby acknowledge, appreciate, and unequivocally agree to the following:

I recognize that engaging in the activities associated with this program carries a significant risk of injury, including the potential for permanent paralysis and even loss of life. While specific regulations, safety equipment, and personal discipline may mitigate these risks to some extent, it is essential to acknowledge that the risk of serious injury remains inherent.

I willingly, knowingly, and without reservation assume all such risks, whether they are known or unknown, even if they result from the negligence of the parties responsible for organizing the event or any other individuals. I accept full responsibility for my active participation in the event.

I willingly commit to adhere to the stated and customary terms and conditions for participation. If I encounter any unusual or significant hazards while participating or being present at the event, I pledge to promptly remove myself from the situation and immediately inform the nearest event official.

I, acting on my behalf and on behalf of my heirs, assigns, personal representatives, and closest relatives, hereby RELEASE AND EXONERATE the Releasees, including their officers, officials, agents, employees, fellow participants, sponsoring entities, advertisers, and, if applicable, property owners and lessors responsible for the event venue ("RELEASEES"), from any and all liability associated with injury, disability, loss, damage to property, or death. This includes cases where such harm results from the negligence of the Releasees or any other cause, to the fullest extent permitted by law.

I HAVE CAREFULLY READ AND UNDERSTAND THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, COMPREHEND ITS CONTENTS FULLY, AND AM AWARE THAT SIGNING AND SUBMITTING THIS AGREEMENT INVOLVES VOLUNTARILY AND FREELY RELINQUISHING SIGNIFICANT LEGAL RIGHTS WITHOUT ANY FORM OF COERCION OR INDUCEMENT.

Please Print Name*

Signature*