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Ogden City Recreation 2016 Softball SPRING Registration Form Team Fee $380.00 / Make checks payable to Ogden City Recreation Team Name: League: Manager/Coach: Address: City: Zip: Cell Phone: Cell Carrier: (AT&T, T-Mobile, etc.) Will you accept text messages? (Please circle one) Yes No Day Phone: Evening Phone: E-mail Address: HOLD HARMLESS AGREEMENT 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, and its elected officials, officers, its authorized agents, employees and volunteers, 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. Concussion & Head Injury Policy Acknowledgement: I have read the Ogden City Concussion and Head Injury Policy. I have been informed on how to recognize the signs and and agree to abide by the policy. I understand if I am suspected of having a concussion or head injury that I will be removed from the sporting event and will not be permitted to continue participating in any Ogden City sporting events until a qualified Health Care Professional has determined it to be safe. I will provide Ogden City with a written statement by a qualified Health Care Professional acknowledging I am cleared to resume participation. Within this statement the provider must acknowledge he/she has successfully completed a continuing education course in the evaluation and management of a concussion within three years prior to the date the written statement was made. 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 or 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--- ---PAGE BREAK--- OGDEN CITY RECREATION 2016 SPRING SOFTBALL TEAM ROSTER Team Name: League: PLAYER’S NAME MAILING ADDRESS, CITY, ZIP * SIGNATURE Acknowledgement of Hold Harmless Agreement/Concussion-Head Injury Policy 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.