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FIRST NAME LAST NAME SIGNATURE ADDRESS CITY ZIP CODE PHONE EMAIL 1 2 3 4 5 6 7 8 9 10 11 12 CITY OF ANAHEIM SUMMER 2013 ADULT BASKETBALL ROSTER I, the undersigned, fully understand that participation in the game of basketball is a dangerous activity which exposes me to the risk of personal injury, death, and damage to my property. I hereby agree to assume any and all such risks. In consideration for being permitted to participate in the Adult Basketball Program, I hereby agree for myself, my heirs, administrators, executors, and assigns to release, hold harmless and indemnify the City of Anaheim, its officers, employees, agents, representatives, officials, and volunteers from any and all liability, claims, and actions for any injury, death, or damage to personal property arising out of or in connection with my participation in the Adult Basketball Program from whatever the cause including the active or passive negligence of the City of Anaheim, its officers, employees, agents, representatives, or volunteers. I have carefully read this release, hold harmless and indemnity agreement and fully understand its contents. I understand that it is a full release of all liability and sign it of my own free will. I the undersigned, also understand that I must sign this agreement prior to my participation in the Adult Basketball Program. The City of Anaheim Community Services Department may take and use photos of participants for publicity purposes. I hereby grant the City of Anaheim permission to publish any images taken by the City showing my participation. TEAM NAME: MANAGER NAME: