Simpson Elementary PTA
Kickball Tournament Showdown
($20 per player age 10 & up/$10 per player age 10 & under)
REMEMBER…..BES
T DRESSED or
THEMED TEAM
WILL WIN A
PRIZE!!
Team Name:___________________________________ Team Captain:______________________________________
Address:_________________________________________________________________________________________
Phone:________________________________________ Email:_____________________________________________
Name/Player
Adult= Age 10 & UP
Youth=Age 10 & Under
Paid
T-shirt
Size
Waiver & Release Signature and date
(If under 18, parent MUST sign and date!!)
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**********ROSTERS and fees are due by: May 11, 2015**********
Please send this completed form and money to: Simpson Elementary PTA, PO Box 1322, Bridgeport WV 26330
RELEASE, WAIVER AND INDEMNITY AGREEMENT. I recognize and agree that there are certain risks associated in participating in the
Kickball Tournament Showdown, including risks of personal or physical injury or harm. In consideration for my right, or my child’s right, if
he/she is under the age of 18, to participate in the Kickball Tournament Showdown held by the Simpson Elementary School PTA, I hereby understand
and do agree to assume all of the risks associated with my or my child’s, if under the age of 18, participation in the Kickball Tournament Showdown. I
hereby agree to release, discharge and hold harmless the Simpson Elementary PTA, and any of its members and/or volunteers from any and all
liability, actions, causes of action, claims, expenses and damages, including attorneys’ fees and litigation expenses, for any injury that may occur in the
course of the Kickball Tournament Showdown to me or to my child, if he/she is under the age of 18, even if such injury results in death, and whether
that injury was the result of any negligence, gross negligence, reckless misconduct or intentional act by the Simpson Elementary PTA and/or any of its
members and/or volunteers. I expressly agree that this release, waiver and indemnity agreement is intended to be as broad as permitted by West
Virginia law. If any portion of this release, waiver and indemnity agreement is determined to be invalid or void, then the remaining portions should be
applied so to achieve the intended release, waiver and indemnity, to the fullest extent possible despite such determination.
Your signature above constitutes your acknowledgement that that you have read this waiver, understand it, and voluntarily surrender certain legal
rights as provided for therein.
-Printing Courtesy of PDC Energy