The CAGE - Team Roster

Team Name ______________________________________________________

Send check and forms to:
The CAGE
4484 S. St. Rd. 19
Tipton, IN 46072
Amount Received:__________   Check Number:_______
Lic./SS Number:___________    Date:_______

 
 
   
   
                           
Jersey # Name Address City Birthdate School Attending Grade Shirt Size *Parent/Guardian Waiver Signature
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
TEAM NAME:   Asst. Coach Name:  
Head Coach Name:   Address:  
Address:   City, State, Zip  
City, State, Zip:   Phone:  
Phone:   Cell:  
Cell:   Email:  
Email:   Bench Personnel:                   (1 only)  
*I/we do hereby acknowledge, recognize and accept the inherent risk of bodily injury, disability, paralysis, and/or death to myself/ourselves and my/or my/our children that exists as a result of
my/our participation in any athletic endeavor, and specifically, by my/our participation in athletic endeavors offered or hosted by The CAGE.  As such, I/we do hereby agree to save, hold
harmless, and indemnify The CAGE, its owners, employees, agents, and other individuals or entities operating on behalf of The CAGE, for any bodily injury, disability, paralysis, and/or death, that
I/we and/or my/our children may sustain as a result of my/our participation in any athletic endeavor offered by The CAGE.          
In the event that I/we or my/our children suffer some type of injury or illness which requires immediate medical treatment, I/we do hereby consent to and authorize the administration of such
first aid and/or medical treatment to myself/ourselves and or my/our children by employees and/or agents of The CAGE trained to administer such first aid and/or medical treatment.  I/we do 
further consent to and authorize employees and/or agents of The CAGE to arrange for ambulance transportation for an appropriate medical facility for me/us and/or children.  

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