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OGDEN CITY RECREATION 2016 ADULT BASKETBALL SPRING REGISTRATION FORM TEAM FEE $400.00 Games will be played on Tuesday nights Return registration form and check (payable to Ogden City) to Ogden City Recreation, 1875 Monroe Blvd, Ogden UT 84401 Team Name: League: Manager/Coach: Phone Address: City E-Mail Address: Additional Team Contact: Phone: Previous Team Name: Division: Sponsor: Phone: Contact: Title: Address: HOLD HARMLESS / MEDICAL INSURANCE / INFORMED CONSENT AGREEMENT I, the undersigned * (on the back of this roster), in consideration of the permission granted to me by the City of Ogden and Ogden City Recreation to participate in this recreation program, do hereby release, forever discharge and agree to Hold Harmless Ogden City, Ogden City Recreation, their successors and assigns, for all claims, damages, demands, actions and causes of the action at law or in equity, arising by reason or in manner growing out of participation in Ogden City Recreation Programs. I recognize that recreation and sport activities may involve a degree of physical and/or emotional stress and may cause physical and/or emotional injuries. To the best of my knowledge, I am free from any serious health problems that would prevent me from participation in sports or recreation activities. I recognize that there are specific rules that govern play and I agree to abide by them. I acknowledge that a violation of these rules may result in my not being allowed to continue in this activity. Media Release: From time to time you may be involved in media coverage. Agreeing to media coverage does not in any way imply that you will be video taped, photographed of interviewed, it simply indicates that you give Ogden City permission to allow you to be video taped, photographed or interviewed during this recreation activity. Further, I understand that Ogden City does not provide accidental medical insurance coverage for participants while engaged in sponsored recreation activities. Securing appropriate medical insurance coverage is the responsibility of the participant, or participant’s family. Signature Date ---PAGE BREAK--- TEAM ROSTER Ogden City Recreation 2016 ADULT BASKETBALL REGISTRATION FORM Requested information and signature must be filled in for each player before they can participate. Team Name: League: PLAYER’S NAME ADDRESS, CITY, ZIP * SIGNATURE Hold Harmless Agreement on the other side of roster. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.