#2011-1
St. Anne’s Young Adult Recreational Coed Volleyball League
REGISTRATION FORM
May 23rd – June 20th, 2011
Registration Deadline Postmarked Monday June 20th, 2011
(All Fields Must be Completed to be Accepted)
Today’s date:
PARTICIPANT INFORMATION
Last:
First:
Is this your legal name?
Yes
Middle:
Mr.
Mrs.
If not, what is your legal name?
Miss
Ms.
Are you a member of St. Anne’s?
Yes
No (If Not Where?)
(Former name):
Age:
Sex:
No
M
Street address:
Email:
Phone no.:
(
P.O. box:
F
City:
State:
Houston
TX
)
-
ZIP Code:
LEAGUE INFORMATION AND QUESTIONS
Fees (Made Payable to St. Anne’s Young Adults)
League Jersey Fee -- $15.00 (New and Team Switching Players
Only)
League Administrative Fee -- $10.00 (All Players)
Late Fee (If not postmarked/emailed by deadline below) -- $15.00
What is your T-Shirt Size (Men’s):Past Player No Shirt Requested
*If you are a returning player requesting the same team you are exempt from a t-shirt purchase but if you are placed on another team you must
purchase a t-shirt for that new team*
Skill Level (Please select one in each category)
Competitiveness:
Athletic Ability:
1 (least competitive)
1 (not athletic)
Have you played volleyball
within the past year?
Yes
2
2
3
3
No
4
4
5
6
7
8
9
5
6
7
8
9
Who have you played volleyball with recently?
SAYA
Other:
10 (most competitive)
10 (very athletic)
Team Preference (Please List)
None
Preferred Team To Be Placed On: Other
Individuals you wish to play with:
*Please note that we attempt to balance skill level across the league and thus we cannot guarantee you will be on any one team*
Registration Packet Checklist (Please return to Co-Sports Directors via US Postal Service/Email) –Deadline Monday June 20th, 2011 postmarked
Registration Form
Check Made Payable to SAYA
Liability Waiver
Ralph Crivello (rkc5008@gmail.com) 2412 Bevis St. Houston TX, 77008 (412) 266-2435
Margaret Dieta ( magsd@me.com)
*Note – No registration will be accepted past the late late deadline of July 10th*
Summer Season Schedule
Regular Games Sunday July 10th, 17th, 24th, 31st, August 7th, 14th & 21st 2011; location St. Anne’s Gym
Sunday August 28th, 2011 Tournament; location TBD
IN CASE OF EMERGENCY
Name of local friend or relative (not living at same address):
Relationship:
Home phone no.:
Work phone no.:
Friend
(713)
(713)
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SAYA RECREATIONAL COED PARTICIPATION AGREEMENT REGARDING
ASSUMPTION OF RISK, RELEASE OF LIABILITY, AND INDEMNIFICATION
I, First Middle Last, desire to participate in intramural activities (“Intramural Sports”) at St. Anne’s Catholic Church through
the Saint Anne’s Young Adults (“SAYA”) group 2140 Westheimer Rd Houston, Texas 77098 (referred to as the “Church”)
and in consideration of being allowed to participate in Intramural Sports, I hereby acknowledge and agree as follows:
I. I am fully informed or otherwise aware of, and fully assume, all risks to person and property in connection with my
participation in Intramural Sports, (including, but not limited to, damage and loss of property, bodily injury, medical
treatment and death). I am in good physical and mental health and do not have any physical or mental conditions which
could affect my ability to participate in Intramural Sports. I have medical insurance coverage appropriate for my participation
in Intramural Sports. The Church shall not provide any insurance for me in connection with my participation in Intramural
Sports.
II. I fully and forever RELEASE, WAIVE AND DISCHARGE, AND COVENANT NOT TO SUE, the Church,
(including, but not limited to, any groups or affiants, its trustees, employees and representatives) from and for any
and all demands, claims, actions, suits, damages, losses, liabilities, costs and expenses arising, directly or indirectly, in
connection with my participation in Intramural Sports from any cause whatsoever (including, but not limited to,
damage and loss of property, bodily injury, medical treatment and death), whether or not foreseeable or contributed
to by the negligent acts or omissions of the Church or others.
III. I shall INDEMNIFY AND HOLD HARMLESS the Church (including, but not limited to, any groups, its trustees,
employees and representatives) for and from any and all demands, claims, actions, suits, damages, losses, liabilities,
costs and expenses arising, directly or indirectly, as a result of my intentional or negligent acts or omissions from any
cause whatsoever (including, but not limited to, damage and loss of property, bodily injury, medical treatment and
death), whether or not foreseeable or contributed to by the negligent acts or omissions of the Church or others.
IV. I shall fully comply with all applicable laws, Church policies and Intramural rules and regulations while participating in
Intramural Sports. If my participation in Intramural Sports is at any time deemed detrimental to Intramural Sports or any
other participants, as determined by the SAYA in its sole discretion, I understand that (i) I may be removed or suspended
from Intramural Sports without the Church or SAYA without refund of recreation fees or charges incurring any liability and
(i) I may be subject to further disciplinary action.
V. This Agreement constitutes the entire agreement, and supersedes any prior or contemporaneous agreements,
understandings, or negotiations, with respect to the subject matter hereof. This Agreement (i) may not be amended or
modified, by course of conduct or otherwise, and (ii) may not be assigned or transferred, in whole or in part, except in writing
duly executed by me and the Church. This Agreement shall be governed by, and construed and enforced in accordance with,
the laws of the State of Texas, without regard to the conflicts or choice of law principles thereof, and shall be as broad and
inclusive as permitted by such laws. In the event that a court of competent jurisdiction shall hold any provision of this
Agreement unenforceable, such unenforceability shall not affect any other provision, and this Agreement shall be construed
as if such provision, to the extent of such unenforceability, had never been incorporated herein.
VI. I (i) have read and fully understand this Agreement, (ii) intend that this Agreement be legally binding upon and
enforceable against me and my family members, estate, heirs and legal representatives, (iii) intend that this Agreement inure
to the benefit of the Church, and (iv) confirm that I am at least eighteen years of age, fully competent, and entering into this
Agreement voluntarily of my own judgment.
IN WITNESS WHEREOF, I have duly executed and delivered this Agreement as of
.
Signature:
Note: Signature in ink or valid electronic signature will only be accepted
Printed Name:
First Middle Last
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