Roster and Waiver
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Roster/Waiver/Payment Form
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Syracuse Can-AmPlace Team Name HereMen or WomenHome ColorAway Color
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Player NamePlayer/Parent Email (Optional)Player/Parent Signature
Player/Parent Cell
Jersey #
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TO ALL Syracuse Can-Am PARTICIPANTS: If you intend to play in a sport in which there may be body contact with other players, with
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equipment on or surrounding the playing field and with a ball moving at high speed with such contact occurring at some times when your
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attention is directed away from the cause of the contact we ask that you acknowledge that the potential danger exists, that you are eng-
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aging in this activity at your own risk and that you will not hold the Cicero Twin Rinks or those running the event harmless
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for any injury sustained in the playing areas that is the result of your participation in this activity. I have read this waiver form carefully.
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I accept its terms and agree that I am solely responsible for any injury by me while participating in the broomball tournament event.
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Any player under 18 years of age must have a parent/guardian sign for them.
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All participants MUST sign this document.
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Captain/Team Manager
Captain/Team Manager Email
Captain/Team Manger Signature
Cell NumberDate
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