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BUTTE-SILVER BOW PARKS AND RECREATION DEPARTMENT 126 WEST GRANITE STREET BUTTE, MT 59701 TELEPHONE: [PHONE REDACTED] Recreation Activity/Release Form Please check appropriate activity: Softball: ($385/team) Football: ($150/team) Women’s Volleyball: ($75/team) Mixed Volleyball: ($75/team) Football: ($150/team) Basketball: ($225/team) Team Name: Date: Team Manager: Email: Phone: Gym/field played in previous year (if any): Someone who can be reached on Mondays (daytime phone): Team Division: Team rosters must be completed in each player’s own handwriting for the Parks and Recreation Department. All additions and releases must be cleared with the Parks and Recreation Director. Player rosters and dues must be filed at Parks and Recreation one week prior to the start of the activity. We, the undersign members, do hereby agree to accept complete responsibility in matter of any physical injury or loss that might result from participation in the games, practice, or travel to or from such activities. We further agree that in the event of such injury or loss that there shall be no liability on the part of Butte-Silver Bow or any group associated in the sponsorship of the activity. Player’s Name Player’s Signature Email Address Phone Number Staff only: Date: Fee: Receipt Number: