INTRAMURAL SPORT_________________________________________________________

MEN'S___________ WOMEN'S___________ CO-ED________

TEAM CAPT. ________________E-MAIL ADDRESS______________PHONE NUMBER______________
CO-CAPT.___________________E-MAIL ADDRESS______________PHONE NUMBER_____________

TEAM AVAILABILITY

CAN PLAY: --------------- MON. ---------------- TUES. -------------WED. ----------------- THUR. -------------- FRI. --------------- SUN.

----- 4 P.M. ----- 5 P.M. ---- 6 P.M. ---- 7 P.M. ---- 8 P.M. ---- 9 P.M ---- 10 P.M. ---- 11 P.M.---- 12A.M. ---- 1 A.M. ---- 2 A.M.

INFORMED CONSENT STATEMENT

Participation in SUNY Geneseo intramural events is voluntary. The undersigned acknowledge his / her understanding that the possibility of injury exist when participating in intramural events. Possible injuries that may occur are cuts, bruises, muscle strains, sprains, broken bones, concussions, and dislocations.

The participant acknowledges his / her awareness that in the event of an injury, no compensation is available from Recreation and Sports, SUNY Geneseo, or the State of New York, their members, agents, or employees. The participant's responsibility to obtain appropriate insurance or pay all charges associated with the injury is hereby confirmed.

I confirm that I have read the informed consent statement by signing below. I have signed this statement on my own free will and for the purpose of participating in activities that are sponsored by the SUNY Geneseo Recreation Department.

NAME --------------------------------- E - MAIL ---------------------------- PHONE NUMBER -------------------- SIGNATURE

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WHEN REGISTERING FOR AN EVENT, ALL INFORMATION ON SHEET MUST BE COMPLETED.
RETURN TO MERRITT ATHLETIC CENTER 232.