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REGISTRATION
AND PAYMENT MUST BE RECEIVED BY 4/01/10
Please print and fill out both pages neatly and completely. Mail along with check or money order for $150.00 payable to: TYCO SPORTS
301 Route 940 Mount Pocono, PA 18344 Credit card payments will be processed by phone. (We will call you once we have received your completed registration form) QUESTIONS? CALL STEVE @ 570-656-5200 |
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NAME:
_____________________________________________________________________________________ ADDRESS:________________________________________________________________________________________ CITY: _____________________________________ STATE: ______________________ ZIP CODE: _____________ HOME PHONE:_________________________________ CELL: ____________________________________________ EMAIL ADDRESS:_________________________________________________________________________________ LEAGUE STATUS (check one): [ ] NEW PLAYER [ ] RETURNING PLAYER TEAM STATUS (check one) [ ] NO TEAM / OTHER ____________________________ [ ] Penalty Box [ ] Monavie' [ ] Shenanigans [ ] Tyco Homes [ ] Sara Street [ ] 24 Hour Gym The Conduct Statement, Waiver and Release of Liability, and Photography and electronic media release must be read, signed, and submitted as part of your registration in order to participate. Payment does not guarntee playing time. No Refunds, No Exceptions. CONDUCT STATEMENT I agree to abide by the general rules of conduct prescribed for participation in the Tyco Sports Flag Football League as posted on the league website, www.tycosports.net. I understand that among these rules are prohibitions against abusing officials, profanity, flagrant fouls, and any other unsportsmanlike behavior. I further understand that violations of these rules will result in game ejections, suspensions and/or possible permanent dismissal from the league. I have read and understand the Conduct Statement. SIGNATURE______________________________________________________ DATE___________________ CONTINUED ON PAGE 2 WAIVER AND RELEASE OF LIABILITY I know participating in flag football games and events organized or sponsored by Tyco Sports Flag Football League is a potentially dangerous or hazardous activity. I assume all risks associated with my participation in such events, including, but not limited to, falls, contact with other participants, conditions of weather including rain, ice, snow and cold temperatures, the conditions of the field, etc., all such risks being known and understood by me. Having read this Waiver and Release of Liability, knowing the risks associated with my participation in football related activities, and in consideration of being permitted to participate in the Tyco Sports Flag Football League, I for myself and anyone entitled to act on my behalf, waive and release the Tyco Sports Flag Football League, its officers, representatives and members from all claims or liabilities of any kind arising out of my participation in the Tyco Sports Flag Football League though that liability may arise out of negligence or carelessness on the part of the persons identified in this Waiver and Release of Liability. I further release the Tyco Sports Flag Football League, its officers, representatives and members from any claim whatsoever on account of first aid, treatment or service rendered to me in connection with my participation in the Tyco Sports Flag Football League. I further acknowledge that this Waiver and Release of Liability is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Pennsylvania, and that if any portion thereof is held invalid the balance shall, notwithstanding, continue in full legal force and effort. In witness whereof, I have executed this Waiver and Release of Liability on the date indicated below. SIGNATURE______________________________________________________ DATE___________________ PHOTOGRAPHY AND ELECTRONIC MEDIA RELEASE I hereby grant permission to the Tyco Sports Flag Football League its assigns, licensees, and legal representatives, the irrevocable right to use my name, picture, portrait or photograph on its World Wide Web site, in electronic media (e.g., video, CDROM, etc.) or in other printed publications or other forms of promotion without further consideration, and I acknowledge the Tyco Sports Flag Football League's right to crop or treat the photograph at its discretion, and waive my right to inspect or approve the finished product, including written copy, which may be created in connection therewith. I also acknowledge that the Tyco Sports Flag Football League may choose not to use my photo at this time, but may do so at its own discretion at a later date. I also understand that once my image is posted on Tyco Sports Flag Football League’s website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless from any claims the following: The Tyco Sports Flag Football League, the photographer, their offices, employees, agents and designees, including league officers. SIGNATURE______________________________________________________ DATE___________________ CHECK ONE: [ ] PAYMENT ENCLOSED [ ] PLEASE CALL ME FOR CREDIT CARD PAYMENT THERE WILL BE A $25.00 FEE FOR ALL RETURNED CHECKS |
| SHIRT SIZE (check one): [ ] SMALL [ ] MEDIUM [ ] LARGE [ ] X LARGE [ ] 2X LARGE AGE: ________________ [ ] Check this box if you are interested in becoming a team captain |