Sebastian Old Boys Member Application



Name: __________________________________________________________________________________

Local Address

Street ____________________________________________________________________________


City: ________________________________________    State: _____________     Zip: _____________


Telephone: ________________________      E-Mail: _______________________________________________


Age: ________    Date of Birth___________________    T-Shirt Size (Circle One):     S     M     L     XL    XXL



Primary Emergency Contact Name: _________________________________    Phone#: __________________


Secondary Emergency Contact Name: _______________________________    Phone#: ________________


Sebastian Old Boys Waiver


In consideration of my participating in the Sebastian Old Boys Organization, I the undersigned (or parent/guardian), intending to be legally bound, do hereby, for myself, my heirs, my personal representatives and assigns, waive, release, and forever discharge any and all rights and claims for damages which I may have or hereafter occur to me against the Sebastian Old Boys Organization, the city of Sebastian, sponsors, or their officers, agents, representatives, successors and or assigns from any and all damages, claims, injuries or actions sustained or suffered in connection with my participation, association and or playing in the Sebastian Old Boys Organization.

Further, I attest and verify that I have full knowledge of the risks involved in participation in the Sebastian Old Boys Organization, and I am physically fit and trained to compete.

I also agree to abide by the rules and regulations set up by the officers of the Sebastian Old Boys Organization.


Applicants Signature in full: _________________________________________________________


Printed Name: ___________________________________________________ Date: ___________________