REGISTRATION NUMBER  
TEAM NAME -- LOCATION  
MANAGER NAME / PHONE
ADDRESS		  
CLASS  
DATE FROZEN  
PLEASE READ BEFORE SIGNING
In consideration of being allowed to participate in any way in the UNITED STATES SPECIALTY SPORTS ASSOCIATION athletics/sports program, related events and activities, the undersigned 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 the 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 all 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 of kin, HEREBY RELEASE AND HOLD HARMLESS THE UNITED STATES SPECIALTY SPORTS ASSOCIATION, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the 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.
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, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
PARENTS/GUARDIANS SIGNATURE SHOULD BE ON THE SAME LINE AS PLAYER'S NAME APPEARS ON THIS ROSTER. By signing this roster, parent or legal guardian agrees to the above statements and verifies that the date of birth is correct. Parent or legal guardian of each youth player must sign below. FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as parent/legal guardian with legal responsibility fir this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above. EVEN IF ARISING FROM THEIR NEGLIGENCE.
PLAYER DATE OF
BIRTH		 ROSTER
AGE		 PLAYER
SIGNATURE		 PARENT/GUARDIAN RELATIONSHIP
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
 
TEAM MANAGER'S AFFIDAVIT - I, the manager of the above team, do hearby state that all of the information supplied is correct to the best of my knowledge and that all of the parents or guardians signed the above in their own handwriting. I further agree that each player is eligible to compete with my team in the USSSA Program in accordance with the USSSA rules governing that sport.

IMPORTANT - Each team manager shall be responsible to keep legal copies of birth certificates, etc., at all times in case of protest.

MANAGER'S SIGNATURE: _____________________________________________________ DATE: ___________________________
USSSA DIRECTOR'S APPROVAL - The above team is registered with the USSSA and has qualified to participate in this event.

SIGNED: _______________________________________________________________
             USSSA STATE SPORTS DIRECTOR