4-on-4 League Registration – Summer-3 ’19 Session Please complete this registration form to register for Bumpy Pickle Beach’s 4-on-4 sand volleyball league.$240/ team (or $62 individually) 1 Your Information2 Team Information3 The Waiver4 Emergency Contact5 Payment Your InformationYour Name* First Last Gender*FemaleMaleBirthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your Email* Your Phone Number* Team InformationRegistration Type*Team - $240Individual - $62Skill Level*RecreationalIntermediateAdvanced IntermediatePreferred Match Day*Monday night - RECWednesday night - REC & INTERMSunday afternoon - ADVTeam NameTeammate's Name First Last Teammate's Email Teammate's Phone Number WaiverAssumption of Risk, Release, and Indemnity Agreement Assumption of Risk: I understand that the Activities* in which I (or my child) will engage in using personal property or other recreational equipment owned by BUMPY PICKLE BEACH, LLC (hereinafter “BPB”) involves inherent and other risks. I acknowledge that the Activities are dangerous and require a certain degree of physical condition, ability, maturity and skill. I acknowledge that I am solely responsible for determining my (or my child’s) suitability to participate in the Activities. I have (or my child has) the requisite skills, qualifications, physical and mental ability, and training necessary to properly and safely participate in the Activities. I (or my child) share(s) responsibility for my (his/her) safety and will follow instructions, make reasonable decisions, and act responsibly. BPB cannot ensure my (or my child’s) safety. I choose to voluntarily participate (or allow my child to participate) and observe the Activities despite all risks. I assume all inherent and other risks and accept responsibility for any property damage and loss, and for any personal injury, illness, disability, emotional distress, and death that I (or my child) may suffer, whether described above or not. In consideration of B.P.B. allowing me (or my child) to participate in or observe the Activities, I agree to the following: Waiver and Release: I, (and on behalf of my child) agree to forever release and discharge BUMPY PICKLE BEACH, LLC from and agree not to sue for any and all liability or claims I (or my child) may have for any property damage and loss, personal injury, emotional distress, illness, disability, and death, related to my (or my child’s) participation in the Activities or use of any personal property or recreational equipment. This release is for any type of claim, suit and or loss alleged to be caused by the negligence of BPB to the fullest extent permitted by law, but does not include claims for gross negligence. Indemnity: I agree to defend, indemnify (meaning to pay or reimburse any amount required to be paid, including reasonable attorneys’ fees from attorneys approved by BPB, and hold BPB harmless from all claims, causes of action, liability, losses, or damages for any property damage, property loss or theft, personal injury, disability, death or other loss brought by or on behalf of me, my child, a family member, my estate, another participant or spectator, or other person arising from or relating to participation in the Activities, including claims that BPB was negligent. Additional Provisions: I agree that the substantive laws of Texas (but not any law that would apply the laws of another state) govern the Agreement and any dispute I have (or my child has) with BPB and consent to jurisdiction in Texas. Any mediation, suit, or proceeding will be entered into only in Texas. Any portion of this Agreement deemed unlawful or unenforceable is severable and shall be stricken without effect on the enforceability of the remaining provisions. I also acknowledge reading and understanding the Rules and Regulations relating to the Activities. I agree to comply with and abide by those Rules and Regulations. I have read this Agreement, I understand its contents and I sign it voluntarily. I intend by this Agreement to assume all hazards and risks, waive all rights to sue and release all liabilities and claims, and indemnify BPB for any claims arising from my (or my child’s) participation in the Activities. I understand that this Agreement has no expiration date and remains in effect at all times that I am (or my child is) observing or participating in the Activities, and will be binding on me, my family members, my heirs, assigns, executors, representatives, and estate. The following is a list of the inherent risks associated with the Activities1 or use of the personal property and/or recreational equipment owned by BPB. This list does not include all inherent risks but serves to provide examples and promote an understanding of the risks: Death Head trauma and facial injuries Fractures, dislocations, sprains, strains and other soft tissue injuries Contusions, lacerations, abrasions, and various forms of blunt force trauma Complications associated with exposure to weather and physical exertion Impacts with other individuals or participants and/or their equipment Perils and hazards arising from other guests / participants Perils and hazards arising from natural features, plants, animals, insects, wet surfaces, tripping hazards and other types of contact with man-made and natural features Falling while entering or exiting the sand courts, patio(s), deck(s) or other areas of the property Rules And Regulations Observe all posted signs and warnings as well as obey all instructions given by BPB or agents All participants must use all equipment in the manner directed by BPB or their agents Always remain in control Do not drink alcohol prior to or while participating in any Activity or using the personal property/recreational equipment I have read the Inherent Risks and the Rules and Regulations, I understand its contents and I sign it voluntarily. Activities are defined as all sporting, recreational and competitive activities associated with or occurring at or near real property owned by Bumpy Pickle Beach, LLC.Participant's Signature*Date* Date Format: MM slash DD slash YYYY Emergency ContactEmergency Contact's Name First Last Emergency Contact's PhoneIs the participant a minor (under 18 years of age)?*YesNoParent or Legal Guardian (if participant is under 18 years of age)I hereby warrant that I have legal authority to act on my child’s behalf. I agree to the above terms and conditions for myself and on behalf of my child. If I am signing for a participant that is not my child, I agree to indemnify BPB as provided in the Indemnity provision above for any and all claims brought by or on behalf of the child for whom I sign or for any claim brought by any other person related to the child’s participation in or observation of the Activities.Name of Parent/Guardian of Participating (if minor)* First Last Parent/Guardian Signature*Date* Date Format: MM slash DD slash YYYY Payment DetailsTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name *Activities are defined as all sporting, recreational and competitive activities associated with or occurring at or near real property owned by Bumpy Pickle Beach, LLC.4v4 RegistrationCommentsThis field is for validation purposes and should be left unchanged.
