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: ___________________