Kent County Clash

Waiver/Release Participation Form

I hearby request your acceptance of the waiver/release registration form for the 2006 Kent County Clash to be held on Saturday, July 15 at Brown’s Branch County Park. In consideration of your acceptance of the waiver/release, I hear by release all persons associated with the Kent County Clash and Kent County Parks and Recreation from all claims and causes of action arising from injury to the participant in the 2006 Kent County Clash, whether such injury is the result of negligence of any other cause. If medical attention is required for the injury or illness while participating in this event, I give permission for such medical care and I will be financially responsible.

In order to participate in this tournament all players are required to wear a mouth guard and shin guards while on the field of play. Failure to comply will result in dismissal of the player from the tournament. NO EXCUSES, NO EXCEPTIONS!!

IN ORDER TO PLAY, WE MUST HAVE THIS FORM COMPLETED AND SUBMITTED WITH YOUR REGISTRATION PACKAGE. NO FORM, NO PLAY!!

Name: ­­­­­­­­­­­­­­­­­___________________________________________________________

Phone: ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­____________________            Emergency Phone # _____________________

Address: ­­­­______________________________________________________________

                            Street                                           City                                        State                                        Zip

Signature of Participant: __________________________________________________

Signature of Parent/Legal Guardian: _________________________________________

(If Participant is under 18)

Date: _____________________

Team: ____________________