Capital Centre - The Summit

THE SUMMIT Soccer Registration Form

Send to:  Soccer Director, The Summit

9410 Davis Hwy

Dimondale, Mi. 48821

OR

Fax:  517-319-1004

 

Team or Individual Name

________________________________________________________

 

Address

_____________________________________________________________________

 

City _____________________ ZIP________

EMAIL__________________________________

 

Home Phone _________________Work _________________ Cell _________________

 

Division (Please circle)  MALE         FEMALE            COED         Learn To Play CLASS

 

Date of Birth ________ Age Group (Circle One)  U10    U12    U14    U16    U19  Adult

 

Second Team Contact: __________________________Ph 1_____________Ph 2 ___________

 

Payment Method: Check or M.O.# _______

Credit Card #_______________________________

 

Exp. _______Name on Credit Card_________________________________________________

 

Waiver and Release

 

The undersigned (hereafter “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.  While rules, equipment, and personal discipline may reduce this risk, the risk does exist.  Participant freely assumes all such risks, both known and unknown, even if the risk and injury arise from the negligence of Capital Centre Operating, L.L.C.  Participant assumes full responsibility for Participant related to any and all such activities.  Participant agrees to comply with stated and customary terms and conditions for participation in any and all activities at The Summit at Capital Centre and/or the Aim High Sports.  If Participant observes any unusual significant hazard during his/her presence or participation, Participant will remove himself or herself from proximity to the hazard and bring the hazard to the attention of an authorized representative of Capital Centre Operating, L.L.C.  Further, Participant hereby releases, indemnifies and holds harmless Capital Centre Operating, L.L.C.; Capital Centre Properties, LLC; Capital Centre Concessions, LLC and their members, owners, officers, employees, coaches, 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 and Aim High Sports are located,

(hereafter collectively called “Releasees”), from all claims and expenses, including actual reasonable attorney’s fees, arising out of, or related in any way to, Participant’s activities at The Summit at Capital Centre and/or Aim High Sports  including, but not limited to, such claims alleged to arise from the sole negligence of the Releasees.

 

I HAVE READ THIS WAIVER AND RELEASE AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY.

 

______________________ ___        ______________________

Participant’s Name Printed   Age                      Participant Signature  

 

FOR PARENTS/GUARDIAN OF PARTICIPANTS UNDER THE AGE OF 18 AT TIME OF REGISTRATION

 

As parent/guardian with legal responsibility for this Participant, I do hereby consent and agree to the full release of all claims by Participant expressed above, and for myself, my heirs and assigns, I hereby agree to indemnify and hold harmless the Releasees from all claims and expenses, including actual reasonable attorney’s fees,  arising out of, or related in any way to, Participant’s activities at The Summit at Capital Centre and/or Aim High Sports facilities including, but not limited to, such claims alleged to arise from the sole negligence of the Releasees.

 

______________________________________ _______   

Parent/Guardian’s Signature Date

_______________________________

Emergency Phone Number