2013 White Pigeon Alumni Football Game
Participation Agreement
Name: _____________________________________________________
Phone Number: _____________________________________________
Address: _____________________________________________________________________
Drivers License #: _________________________________________________________________
J
ersey Number: ____________________ Year(s) Played: __________________________
We are wearing red. You can wear your own jersey.
White Pigeon Community Schools will provide you use of any of our equipment and/or facilities that
you may need for the game. All equipment must remain in the White Pigeon High School locker room
at all times. You will be allowed to take pants and jerseys home to wash them after practices – game
equipment will be collected immediately following the contest. All equipment must be returned at the
conclusion of the game, or you will be billed for it. Equipment (including all cloth items) does not need
to be washed after the game to be returned. A $50.00 fee for equipment and facilities use is required
to be paid in full before any player may participate in any practice or game.
Rules of Personal Conduct:
1. State law prohibits tobacco use on all school grounds.
2. No one may participate in practice or the alumni game while under the influence of alcohol or
drugs.
3. Players must work with the alumni coaches in a positive manner.
4. Players must exhibit sportsmanship, and fair play at ALL times.
5. All players will play during the alumni game, but due to realities of game situations, equal playing
time cannot be guaranteed of playing at specific positions.
6. No fighting or arguing among players or between players and coaches will be tolerated.
7. The decisions of game officials are final. No arguments are allowed.
8. Only players who played varsity football for and graduated from White Pigeon Community Schools
may participate on the White Pigeon Alumni Team.
9. Violation of rules will result in the player(s) being asked to leave immediately, will not be allowed to
participate further, and will not be refunded the $50.00 fee.
10. Have fun and be safe.
Game Rules:
1. Your oldest players will play the first series of the first and second half until the punt.
2. No blocking below the waist.
3. You must run your “base” defense.
4. No blitzing.
5. No defensive line stunts.
6. Unlimited time outs.
7. Cannot rush the punter or place-kicker.
8. No fake punts, fake extra-points, or fake field goals.
9. No onside kicks.
Game rules are subject to change as necessary to protect the health and safety of
the participants.
I, ________________________________________ (print name) recognize and
acknowledge that certain inherent risks of physical injury are present and may
occur to participants in athletic activities and the proposed football game and
preparation thereof. I assume and accept these risks and full responsibility for the
results of any injuries, including death, sustained from participation in the 2012
White Pigeon Football Alumni Game, including any and all expenses for medical
treatment. I hereby acknowledge the White Pigeon Community Schools does not
provide or maintain medical insurance coverage for participants in this athletic
activity, that as a participant it is my responsibility to maintain medical
insurance coverage and that I should not have and maintain medical insurance
coverage, the expenses for any and all such medical treatment shall be my sole
responsibility and liability.
Further, I hereby agree to discharge and release the White Pigeon Community
Schools and the Centreville Public Schools and their Boards of Education,
including their individual Board members, employees, agents and volunteers
from any and all claims, complaints, demands and causes of action of any kind
whatsoever arising and resulting from any injuries sustained by participant,
including death, as a result of participation in the 2012 White Pigeon Alumni
Football Game. In addition, I hereby agree to indemnify and hold harmless the
White Pigeon Community Schools and the Centreville Public Schools and their
Board of Education, including their individual Board members, employees,
agents, and volunteers from any and all liability, damages, or other losses
incurred as a result of any such claims, complaints, demands and/or causes of
action that may be brought against any of them. I also agree to follow the rules
for use for equipment and personal conduct during practices and games.
I acknowledge that I have read this Participation Agreement and Release and
understand all of its terms. I sign it voluntarily with full knowledge of its
significance and agree to abide by its terms. No oral representations, statements,
or inducements apart from the foregoing agreement have been made. This
agreement is binding on the signer-participant and his or her respective
successors, assigns, and heirs.
Please make checks payable to the White Pigeon Football Program
Signature: _______________________________________________ Date: _____________
Printed Name: ______________________________________________
Relive the Glory Days for One Night!
Friday, June 21, 2012
@ Centreville High School – 7:00 p.m. Kickoff
White Pigeon Alumni vs. Centreville Alumni
Full Contact
Practice Dates: June 16th – June 20th
@ White Pigeon High School
Pat West and Marv Schneider will Coach the W.P. Alumni
Any Questions Contact Joseph Morsaw at
[email protected] or call (269) 483-7679 x203