Empire Roller Rink's Adult Roller Hockey Leagues Sign-up & Release Forms  2010
Team Name: ___________________________________________________________ Captain Name: __________________________________________________________ Individual Player Info: Name:_______________________________________Date of Birth_____/_____/____. Address:_______________________________________________________________ City____________________________St._______________zip___________________ Home phone:_______________________Cell phone:___________________________ Email address: (Required)_______________________________________________________________                                                       Reminder:  A game or practice can be rescheduled at anytime. J
RELEASE In consideration of the right to use Empire Roller Rink for purposes of conducting hockey instruction, practice, League Play associated activities,______________________________________________________________ (hereinafter "Releaser"), for himself, his heirs, executors, administrators, and assigns, does hereby full release Empire Roller Rink (hereinafter "Releasee"), and all other employees and agents, from all claims, demands and cause of actions, and all liability whatsoever, by reason of any injury which arises from the premises above - stated purposes. This release pertains to any disputed claim, and does not constitute an admission of liability for any occurrence on the part of said Releasee. It is understood and agreed that the continued use of the skating rink is the consideration for this Release; that the consideration is contractual and not a mere recital; and that all the agreements By his signature. Releaser acknowledges that he has read and understands all foregoing, and that he agrees to be bound by this Release. RELEASER SIGNATURE:___X_____________________________________________ PARENT OR GUARDIAN (IF UNDER AGE 18) SIGNATURES: _X_________________________________________________________________________________________                            YOU CAN FAX THIS FORM TO:    (573) 256-7375                                             or email it to:    Mark@EmpireRollerRink.com
___________________________________________________ Adult Roller Hockey Team Roster Date:                                                               Team Name:                                                                          Captain Name :                                                                             Captain Cell Phone:                                                                      Players Names & Phone #'s _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Please email forms to Mark@EmpireRollerRink.com or Fax to: (573) 256-7375.