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VERO BEACH CODGERS MEMBER APPLICATION
In consideration of my playing in the Vero Beach Codgers Senior Softball League, I the undersigned, intending to be legally bound, do hereby, for myself, my heirs, my personal representatives and assigns, waive, release, and forever discharge any and all rights and claims for damages which I may have or hereafter occur to me against the Vero Beach Codgers Senior Softball League, the city of Vero Beach, Indian River County Recreation Department, sponsors, or their officers, agents, representatives, successors and or assigns from any and all damages, claims, injuries or actions sustained or suffered in connection with my association and or playing in the Vero Beach Codger Senior Softball League.
Further, I attest and verify that I have full knowledge of the risks involved in participation in the Vero Beach Codgers Senior Softball League, and I am physically fit and trained to compete.
Signature in full:________________________________________________________
Date:__________________________________
Name___________________________________________________
Address (Local – Florida)_____________________________________________________________
City________________________________________ State_________ Zip___________
Telephone number________________________________________
Email address (please print neatly)____________________________________________________
Age______________ Date of Birth________________________________
T-Shirt size (circle one) S M L XL XXL
Emergency Contact: Name________________________________
Phone #_______________________________