PVPR CO-ED KICKBALL LEAGUE
Adult League - 18 & Older
June 19th - August 28th
Wednesday Nights
$500/Team

*ROSTER DUE PRIOR TO 1ST GAME*
Sign in to Google to save your progress. Learn more
Liability Emergency Medical Release:
I hereby give my permission to participate in the town sponsored Putnam Valley Parks & Recreation program. I certify that I am physically fit and that I will not hold PVPR or its agencies and/or representatives liable for any accidents and/or injuries incurred during the course of the program. I give my personal consent to be transported to any emergency facility if injury is sustained. I also consent to any treatment, surgery, diagnostic procedure or the administration of anesthesia that may be deemed necessary based on the medical judgment of the attending physician. PVPR will not tolerate abusive language or any type of misconduct at any of its functions.
Team Name *
Team Representative Name: *
Team Representative Email: *
Team Representative Phone #: *
I understand this informed Consent Form & agree to its conditions.  Team Representative Name & Date: *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy