7.b) 2014 Dodgeball Signup FormScandia Park & Recreation Committee
Taco Daze
DODGEBALL TOURNAMENT
Saturday, September 6, 2014 (10 a.m. – 3 p.m.)
Team Registration Form
Division (circle one): Adult Grades 10-12 Grades 7-9 Grades 5-6 Grades 3-4
Team Name: Email:
Team Captain: Phone: 2nd Phone:
Team Coach: (required for 3-6 grade teams)
Address: City: State: Zip:
Team Players (maximum 8):
1 First Name: Last Name:
Phone: Grade/Adult:
2 First Name: Last Name:
Phone: Grade/Adult:
3 First Name: Last Name:
Phone: Grade/Adult:
4 First Name: Last Name:
Phone: Grade/Adult:
5 First Name: Last Name:
Phone: Grade/Adult:
6 First Name: Last Name:
Phone: Grade/Adult:
7 First Name: Last Name:
Phone: Grade/Adult:
8 First Name: Last Name:
Phone: Grade/Adult:
Entry Fee $30 before September 4th or $40 thereafter.
Make checks payable to “City of Scandia.” Mail completed registration form with payments to 14727 209th St. N., Scandia, MN
55073.
Release: I recognize there is a significant element of risk in any sports and/or activity. Knowing the inherent risks, dangers and rigors involved, I certify that I
and/or my family (including any minor children) are fully capable of participating in the activities, and wish to do so as vo luntary participants, and with such
knowledge assume any and all risks while participating in the activities. In consideration of the City of Scandia providing t his program to me and/or my family
and/or legal wards, I hereby waive and release the City of Scandia, and its employees, agents and volunteers, from all actions, claims and demands for
personal injury, including death, arising out of the conduct of the activities. I further agree that I shall not bring any cl aims, demands, legal actions and causes
of action again the City of Scandia, its employees or agents. This waiver of liability does not waive liability for any injuries that I obtain as the result of willful,
wanton or intentional misconduct by the City or any person acting on behalf of the City. Th is agreement shall be governed by and construed in accordance
with the laws of the State of Minnesota. I have read, understand, and accept the terms and conditions stated herein and ackno wledge that this agreement shall
be effective and binding upon me and/or my family and/or legal wards during the entire period of participation in Scandia Park and Recreation activities.
Registrant/Parent Signature:__________________________________________________________________________________________________ Date: _____________________________________