Village of Lewiston Recreation Men's Basketball League
Village of Lewiston Recreation Address: 145 N. 4th Street, Lewiston, NY 14092
Contact us at (716) 754-1990 or recreation@villageoflewiston.com

RELEASE OF LIABILITY
In consideration of permitting the below-named child to participate in games, practices, and other activities of the Village of Lewiston Recreation Department, I, the undersigned as parent or guardian of said minor, do hereby release and agree to hold harmless the Village of Lewiston Recreation Department and its said agents, employees, coaches and volunteers from any liability for bodily injury, personal injury or property damage which may occur to said minor on the part of said program or its agents, employees, coaches and volunteers related to this program.

Team Name *
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Team Captain Name
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Team Captain Home Address
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Team Captain Email Address
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Team Captain Phone Number
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Player 1
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Player 1 Emergency Phone Number
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Player 2
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Player 2 Emergency Phone Number
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Player 3
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Player 3 Emergency Phone Number
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Player 4
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Player 4 Emergency Phone Number
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Player 5
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Player 5 Emergency Phone Number
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Player 6
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Player 6 Emergency Phone Number
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Player 7
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Player 7 Emergency Phone Number
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Player 8
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Player 8 Emergency Phone Number
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Player 9
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Player 9 Emergency Phone Number
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Player 10
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Player 10 Emergency Phone Number
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Are there any game times that DON'T work for your team?
I understand that each team will have to pay $200 for a team fee and $32 per team per week for officials fees. Also a refundable $60 cash deposit is due the first game and will get $60 at end of season as long as your team doesn’t forfeit any games or can be used to pay for refs the final two weeks up to the team captain. *
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