2018 Try-Out Registration Form

2018 Try-Out Registration Form

Player can not have turned 15 years old prior to 9/1/18. Please fill out all applicable fields.

Parent/Guardian Information:


Emergency Contact Information:


MINOR WAIVER/ RELEASE

In consideration of (Childs name listed under “Player Name” on this form) , my child/ward being allowed to participate in any way on the PHILADELPHIA LITTLE QUAKERS team, related events and activities, the undersigned acknowledges, appreciates, and agrees that:


1. The risk of injury to my child/ward from the activities involved in this program is significant, including the potential for permanent disability
and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,


2. I FOR MYSELF, SPOUSE, AND CHILD/WARD , I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS both known and unknown,
EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,


3. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual
significant concern in my child/ward’s readiness for participation and/or in the program itself, I will remove my child/ward from the
participation and/or in the program itself. I will remove my child/ward for the participation and bring such attention of the nearest
official immediately; and,

4. I for myself, my spouse and my child/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND HOLD HARMLESS THE PHILADELPHIA LITTLE QUAKERS, LLC; its directors, officers, officials, agents, employees,
volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to
conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property
incident to my childs/ward’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

5. I, for myself, my spouse, my childs/wards, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY
INDEMNIFY AND HOLD HARMLESSPHILADELPHIA LITTLE QUAKERS and all above releasees from any and all liabilities incident to
my child’s/wards involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent
permitted by law.

or cancel