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: ___________________