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Western Massachusetts Relics Softball Registration
Registration Fee $35. Make checks payable to Western Mass Relics
Send check and completed form to John DaSilva, 84 Coolidge Ave., Ludlow, MA 01056-1718
Phone 413-589-0001 – Cell 413-478-8088 - Email jrdasilva@aol.com
Name:
Address:
City, State, Zip: ,
Home Phone:
Cell Phone:
Can I receive Text Messages?
Service Provider
Email Address:
Date of Birth: (YYMMDD) (YY) (MM) (DD)
Division
Preferred position:
Play Desired:
Relics Support:
Play Options:
Emergency Contact Name and Address:
Name
Address
Emergency Contact PhoneHome Cell Phone
Comments
Amateur Athletic Waiver and Release of Liability
In consideration of being allowed to participate (in any way) in the Western Mass Relics Senior Softball program, related events and activities, the undersigned:
1. Agrees, acknowledges, and fully understands that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, severe social and economic losses, which might not only result from their own actions, interactions, or negligence of others, the rules of play, or the condition of any and all premises or of all premises or of any equipment used; also, that there may be other risks not known to me or not reasonable or foreseeable at this time.
2. Assumes all foregoing risks and accepts personal responsibility for the damages following such injury, permanent disability or death.
3. Releases, waiver, discharges, and covenants not to sue the
Western Mass Relics Senior Softball and the Ludlow Fish and Game Club, their officials, or sponsors, from any and all liability caused in whole or in part by the negligence of the officials or sponsors.



Signature:______________________________________________________________________________ DOB (YYMMDD):___________________

Print Name:­­­­­­­­________________________________________________________________________ Date: ____________________________

Do not write on this line: Check # _____________ Cash _____________ Initials:___________ Date:_____________