Madison Adaptive Sports Program (MASP) Athlete Registration
Pre-Register for MASP Play Days. One time register to participate in the Madison Adaptive Sports Program. After this a monthly RSVP is needed to participate. Play days will be on the 3rd Sat of every month through Dec 2015. The program will be held at Dublin Park, 8324 Madison Pike, Madison, Alabama 35758. Time will be 9 am to 3 pm.
Athlete Name *
First Name
*
Last Name
Age
Street Address
City
State and Zip
Phone number *
Email Address
Parent/Gardian
if athlete under 18 yr of age.
Diagnosis/Disability
How did you hear about MASP
check all that apply
Tell us about the Athlete
PHOTO RELEASE: I give my permission to have photos and/or video recordings taken of me or my child(ren) for publicity purpose during MASP's activities even though we will not receive compensation of any kind for appearing in such photos or video recordings. They may also be used in Madison Adaptive Sports Program (MASP) materials to help in obtaining sponsors and Funding. *
Typing your name here is acceptance of the above terms. Please sign and add today’s date.
Waiver of Liability and Assumption of Risk. Read carefully Typing your name here is acceptance of the above terms. Please sign and add today’s date. *
I understand that my participation or my child's participation in the City of Madison ("City") programs and Madison Adaptive Sports Program ("MASP") maintenance ia a voluntary activity. In Consideration of being allowed to participate in athletic activities, I hereby agree to ASSUME THE RISKS OF PROPERTY DAMAGE, INJURY, ILLNESS, OR DEATH in any way associated with my participation in this activity. I agree to RELEASE, DEFEND, INDEMNIFY, AND HOLD HARMLESS the City, MASPs, its officials, employees, representatives, volunteers, and agents for any and all rights and claims for damages, including attorney fees, I now, and may hereafter have, whether known or unknown, in law or in equity, and arising from or in any way connected with my participation in the MASP activities. I agree that the terms stated herein shall serve as a WAIVER OF LIABILITY AND ASSUMPTION OF RISK for my heirs, estate, executor, administrator, assignees and for all members of my family.
Parent or Guardian Waiver . Read carefully. Typing your name here is acceptance on the terms below. Please sign and add today's date.
A parent or guardian signature is required if the participant is under 19 years of age. By signing this WAIVER OF LIABILITY AND ASSUMPTION OF RISK on behalf of a minor, the undersigned parent or guardian is agreeing to be bound by the above condition on behalf of him or herself AND on behalf on the participant.
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