First Name
Last Name
Street Address
City
State
Zip Code
Cell Number
Work  Number
Home  Number
Email Address
Registration form
Coach/Captain Information
Co-Captain Information
First Name
Last Name
Cell Number
Work  Number
Home  Number
Email Address
Choose a Division
Adult
Youth (SUMMER ONLY)
First
Last
Roster
CELL NUMBER
Waiver
Waiver
In consideration of being allowed to participate in any way in RPSA NYC, related events and activities, the players listed above acknowledges, appreciates, and agrees that:

1. The risk of injury from the activities involved in the program is 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; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next to kin, HEREBY RELEASE AND HOLD HARMLESS RPSA NYC, their officers, officials, agents and / or employees, other participants sponsoring agencies, sponsors, advertisers, and, if applicable, (owners and lessors of premises used to conduct the event (“Releasees”), 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 OTHERWISE; and,

5. I willingly agree to comply with all rules and regulations as stated by RPSA NYC rule book; if applicable

6. I understand that personal injury and liability insurance is not included in the league fee; and,

7. I, do hereby give RPSA NYC, their assigns, licensees and legal representatives the irrevocable right to use of my picture or photograph in all forms and media and in all manners, for advertising, trade, or any other lawful purposes, and I waive any right to inspect or approve the finished product, including written copy, that may be created in connection therewith; and,

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 FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Requests
Uniforms
Color Choice or State the Color you already have
All teams must have RPSA Uniforms
Team Name
I Agree
I Agree
I Agree
I Agree
I Agree
I Agree
I Agree
I Agree
I Agree
I Agree