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Board of Directors
Greenwood School Year
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Flag Football League
Kickball Adult League
2021 All Star Ball
2021 Day of Giving
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Adult Kickball League Registration
Adult League Informa
Indicates required field
Are you registering as an individual or as a member of a team
Member of a team
If you are registering as a member of a team, what is the name of the team? (type N/A if this question does not apply to you)
***All individual players will be placed on a team.
***All members of a team will need to complete your own registration form. Payment will need to be made in one lump sum.
Participant's Contact Information
Do not disclose
Date of Birth (MM/DD/YYYY)
Emergency Contact Information
Emergency Contact's Name
Emergency Contact's Relationship to You
Emergency Contact's Phone Number
Emergency Contact's Email Address
Known Health Concerns
Please list any health concerns BGCCB needs to be aware of during the tournament (i.e. asthma, heart conditions, etc.)
Known health concerns (N/A if this does not apply to you)
I acknowledge this application as my registration to participate in Boys & Girls Clubs of the Coastal Bend (BGCCB) adult league. I will not hold the members of the Board, staff or leaders responsible for injury, which may occur while participating in the BGCCB activity mentioned above. I understand that I am responsible for transporting myself to and from the tournament. I also acknowledge that medical insurance is not provided through BGCCB.
Players who have an unpaid balance will not be allowed to play until payment is made in full.
2. Adult League f
ees are NON-REFUNDABLE due to equipment cost, Referees, and administrative fees.
3. BGCCB has a NO REFUND policy.
Electronic Signature (Adult League Registration)
PARTICIPANT RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:
The risk of injury from the activities involved in this 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,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLI-GENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
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
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Boys & Girls Clubs of the Coastal Bend, 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, to the fullest extent permitted by law.
GENERAL MEDIA & PHOTOGRAPHIC RELEASE
The Boys & Girls Clubs of the Coastal Bend as well as Boys & Girls Clubs of America frequently use photographs information from surveys, and quotes from the members to publicize programs. Your permission is needed to use photos, testimonies, and videos, including information from surveys and/or quotes of you on our web site (www.bgccb.org) in informational brochures, social medina and in news articles. I give my consent for any photographs or reproductions thereof (while he/she is engaged in Club-related activities) and in which I appear or quotes I give to be used in anyway the Club may choose including grant/publicity/fundraising purposes.
General Media & Photographic Release
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Electronic Signature (Release of Liability)
Electronic Signature (Kickball - Rules & Regulations)
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization
. COVID-19 is extremely contagious
and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Boys & Girls Clubs of The Coastal Bend, Inc. (Club) has put in place preventative measures to reduce the spread of COVID-19; however, the Club
that you and/or your child(ren) will not become infected with COVID-19. Further,
attending the Club and/or participating in Club sports leagues could
your risk and/or your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and/or I may be exposed to or infected by COVID-19 by participating in any Club programs and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I and/or my child(ren) may experience or incur in connection with mine and/or my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and/or on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.
Electronic Signature (COVID-19 Release)
By pressing submit, you are stating that you have completed and acknowledged the following documents: Adult League Registration, Kickball Rules & Regulations, and COVID-19 Release.
3902 Greenwood Dr., Corpus Christi, TX 78416