Lacey Elks Soccer Shoot Registration
Event Timing: Saturday October 12, 2019, 9:30am to 10am registration, competition starts at 10am
Event Address: Hebrew Park, 327 Cedar Ave, Lanoka Harbor, NJ
Contact: joehoops406@gmail.com
Age Groups: Under 8 (Born in 2012 or later), Under 10, Under 12, Under 14, Under 16 (Born in 2004 & 2005)
Email address *
Your Name *
Your answer
Relationship to participant *
Participants Name *
Your answer
Boy or Girl?
Street *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Permission to post pictures of child from event? *
I would like to volunteer to help run the event *
Required
Release (To be signed at the event)
Parent or Legal Guardian must read and sign this Elks “Batters-Up” Registration Application and Conditions:
The undersigned, parent/guardian of the above named contestant, herby requests the applicant's registration in the B.P.O. Elks "Batters-Up Contest” and represents that the information set forth in this application is correct. In consideration of such registration and the right of the applicant to participate in the competition, the undersigned does hereby acknowledge and agree that such participation will solely be at the risk of the applicant and the undersigned, without liability to the Benevolent and Protective Order of Elks of the United States of America, its State Association, its subordinate Lodges, and the officers and members thereof (hereafter correctly referred to as the "BPOE"). The undersigned for himself/herself, his/her personal representatives, and successors does herby release and forever discharge the BPOE from any and all claims, demands, liabilities, obligations, damages, costs, expenses, loss of service, actions, and causes of action, including each and every right for payment for damages that said undersigned may now or hereafter have against the BPOE arising out of any act or occurrence incident to the applicants said participation, and/or the engagement of the undersigned in connection therewith. The undersigned hereby gives consent and authorizes the BPOE to use and reproduce without compensation, applicant's name and/or likeness, and to circulate the same for any and all purposes reasonably related to the conduct and promotion of the said competition, and the undersigned does hereby agree to indemnify and hold the BPOE harmless from any and all claims, loss, or damage to the BPOE resulting from or related to the applicants said participation.
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