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First Name:*
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Last Name:*
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Street Address:*
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City:*
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State:*
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Zip Code:*
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Phone Number:*
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Emergency Phone Number:*
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E-Mail:
(Please see note (1) below)
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Birthdate:*
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Gender:*
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Sports:*
(Please see note (2) below)
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Lacrosse
Soccer
Horseshoe
Softball
Badminton
Volleyball |
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Team Name:
(Please see note (3) below)
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Comments:
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(1) Please enter an e-mail address if possible. If you specify an e-mail address,
a copy of your entry form will be sent to the e-mail address you provide.
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(2) Please check the appropriate box for each sport you wish to participate in.
All necessary equipment for soccer and volleyball will be available at the event
and you do not need to bring your own soccer ball or volleyball.
If you wish to participate in lacrosse, please bring your own stick.
No sticks will be available at the event.
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(3) If you plan to participate as part of a team, please enter the
name of the team you plan to participate in. Please note that
each individual participant must complete submit an entry form
regardless of whether he or she is participating as part of a team.
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Release from Liability and Indemnification
We wish to participate in Lago Vista 4th of July Sports.
We, individual(s) or organization, Indemnify and Hold Harmless the Lago Vista
4th of July Council, its Volunteers, the City of Lago Vista from any and all
claims, suits, losses, damages, expenses on account of Lago Vista 4th of July Sports.
Further, the noted individual(s) or organization will defend
the Lago Vista 4th of July and the City of Lago Vista, and its agents from all
claims or bodily injury or property damage arising from their participation in
Lago Vista 4th of July Sports. We understand that we are responsible for
our own safely and actions. By checking the box below, I, the individual named
in the First Name and Last Name boxes above, signify that I
have read this Agreement and understand and agree to all its terms.
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I have read the above Release from Liability and Indemnification
agreement and understand and agree to all its terms.
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I agree
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