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NAME OF CLUB: ____________________________
DIVISION:
Qualifier ______ Mens ________ Womens _________ Youth_____
LIST OF PLAYERS:
The Undersigned individuals release the Rockaway Rugby Football Club, the City of New York, the United States Parks Department and all those associated with this tournament from all responsibility with respect to personal or financial injury that may occur from participating in this event or at the Post-Tournament gathering. We understand the risks involved and we accept those risks. We further state that we are properly insured against injury.
(1)______________________________________________Captain
(2)____________________________________________________
(3)____________________________________________________
(4)____________________________________________________
(5)____________________________________________________
(6)____________________________________________________
(7)____________________________________________________
(8)____________________________________________________
(9)____________________________________________________
(10)___________________________________________________
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