Capital Centre - The Summit

FLAG FOOTBALL REGISTRATION

Please mail to 9410 Davis Hwy., Dimondale, MI 48821

or

Fax to Betsy Smith 517-319-1004

Select League Division (circle one) (Age 16 up) MEN COED

(Circle One) Session 1 - Oct. 28 - Dec 16 Session 2 - Jan. 20- March 9

Team Name or Individual_____________________________________________________

Team Contact ___________________________________________________

Address_____________________________________________________________

City_____________________________ State____ Zip__________

Home Phone_________________ Work Phone__________________

Age_____Birthdate______/________/_______

E-Mail Address:________________________________

Payment Information ($750 per team (Roster limited to 12) OR $75 @ individual)

Registration Amount Due $___________

Total Due ___________

Check#_________ Cash ___________ M.O.# __________

Visa/MC/Discover Card#________________________________________

Expiration Date______/__________Name on card _______________________________________

Capital Centre Operating, L.L.C.

 Release and General Waiver

 The undersigned (hereinafter “participant”) acknowledges and agrees that the risk of injury from activities engaged in at the facilities known as The Summit at Capital Centre and/or Aim High Sports are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. The PARTICIPANT KNOWINGLY AND FREELY ASSUMES ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF The Summit at Capital Centre and/or the Aim High Sports facility. The participant assumes full responsibility for the participation by the participant in any and all such activities.  The participant willingly agrees to comply with the stated and customary terms and conditions for participation in any and all such activities engaged in at The Summit at Capital Centre and/or the Aim High Sports Facility.  If, however, the participant observes any unusual significant hazard during his/her presence or participation, the participant will remove himself or herself from the participation and bring such hazard to the attention of an authorized representative of The Summit at Capital Centre and/or Aim High Sports.  Further, the participant, for himself or herself, and his or her heirs, assigns, personal representatives, and next of kin, hereby releases, indemnifies and holds harmless Capital Centre Operating, L.L.C., The Summit at Capital Centre, Aim High Sports, and their owners, officers, employees, instructors, officials, agents, other users, sponsors, advertisers, affiliates, and the property owners of the real property upon which facilities of The Summit at Capital Centre or Aim High Sports is located (“Releasees”), from all claims with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the Releasees or others involving activities at The Summit at Capital Centre and/or Aim High Sports.

 I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

______________________________________ Age ________

Participant Name (Please Print)

____________________________________________ Date____________   

Participant’s Signature  (Parent Signature if participant is under 18)