ASNW Membership Registration

Adaptive Sports Northwest Membership Registration
Registration Type

Adult Athlete RegistrationYouth Athlete (under 18 years of age) RegistrationNon-Athlete Registration

GENERAL WAIVER OF LIABILITY

TO BE COMPLETED BY ALL PARTICIPANTS
I agree to assume the risks of the event listed below, including but not limited to the possibility of death by physical injury or downing, loss of limbs, broken bones, internal injuries, head injuries, cuts, bruised, sprains, allergic reactions and illness of any other kind. In consideration of the acceptance of my application or registration to participate, I, my heirs, executors, administrators and assignees, waive, release and discharge Adaptive Sports Northwest, its officers, directors, employees, agents and any other personnel officially connected with ASNW activities from all claims of damages, demands, causes of action or suit, and liability of nature, including claims of negligence, arising from or out of the participatory activities.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
I understand that ASNW activities involve risks and exertions, which I voluntarily and knowingly assume. I also understand that I will be solely responsible for mental and physical preparation for these activities. I understand that Adaptive Sports Northwest first aid kits do not contain any drugs for internal use and that I need to disclose and supply these items myself, as necessary. I fully recognize the hazards of participating in ASNW events and activities and voluntarily assume all of the risks associated with such participation.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
I agree that prior to using any equipment, I will inspect, or if a parent and/or legal guardian I will instruct the minor to minor to inspect, the facilities and equipment to be used, and if I and/or the minor believes anything is unsafe, I and/or the minor will advise of such condition(s) and refuse to participate.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
I assume any medical and emergency expenses in the event of an accident, illness or other incapability that results from participation in ASNW activities.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
I understand that I may be endangered by other participants in ASNW activities and that some participants may increase the inherent risks for themselves and for all others participating in ASNW activities.I accept this increased risk.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
I will allow photos of myself or my child as a participant to be used for future Adaptive Sports Northwest publications and website.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
Signature*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD Clear
Parent Signature (if participant is under 18)*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD Clear

PARENTAL/GUARDIAN PERMISSION FOR TRAVEL

(youth under 18 years old)
I herby acknowledge and give permission for the below named minor child whose welfare I am legally responsible for, to participate and travel with my Adaptive Sports Northwest Sports team, their staff, coaches, and volunteers for the purpose of competition during the 2018-2019 season. I further agree to hold harmless Adaptive Sports Northwest, NWBA, USPSA, USABA, US Olympic/Paralympic Organization, Adaptive Sports USA, Disabled Sports USA, the DeWald family, the O’Kain family, volunteers, directors, facilities, staff and the city from any and all demands, claims, expenses, or liability of any nature caused by my acts or omissions while participating at this event. I understand and agree that Adaptive Sports Northwest, or other supporting parties are not responsible for, but not limited to any injury or property damage arising out of competing in these games, even if caused by their ordinary negligence or otherwise. Permission is also given for Adaptive Sports Northwest, participants and/or volunteers to seek or render medical aid for my child in case of medical emergency.*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD
CERTIFICATION UNDER OATH - I DECLARE UNDER PENATLY OF PERJURY PURSUANT TO THE LAWS OF THE STATE OF OREGON THAT I READ THE FOREGOING DECLARATION, KNOW THE CONTENTS THEREOF, AND BELIEVE THE SAME TO BE TRUE.*

Yes
Team Member (Minor) Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD Clear
EXPECTATIONS & CODE OF CONDUCT

TO BE COMPLETED BY ALL YOUTH ATHLETES
ADAPTIVE SPORTS NW—EXPECTATIONS & CODE OF CONDUCT*

I have read the above expectations of Adaptive Sports NW, and agree as an athlete and parent to make a commitment to the organization by abiding by the above. I will express any concerns to coaches, managers, or other ASNW staff.
Athlete Name*

First NameLast Name
Athlete Signature*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD Clear
Parent Signature*

THIS RELEASE HAS BEEN READ CAREFULLY AND ALL ITS TERMS FULLY UNDERSTOOD Clear

Membership Type*

Individual - Suggested Donation $100Family - Suggested Donation $150Volunteer/Coach/Official/PSU
TOTAL Membership Amount
prevnext( X )
USDAnnual Membership- *Suggested Donation Amount
If you already have a role within ASNW, please note your position:
i.e. Head Coach - Goalball
FAMILY MEMBERSHIP ONLY - Please list all ASNW members in your family. Each member will need to complete their own registration.
Please list family members
Notes/Questions you may have for our programming staff?
Once you submit your application, we will contact you shortly to let you know that your membership is complete for the year.

Thank you!
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Adaptive Sports Northwest Membership Registration

Adaptive Sports Northwest Registration

GENERAL WAIVER OF LIABILITY

PARENTAL/GUARDIAN PERMISSION FOR TRAVEL

EXPECTATIONS & CODE OF CONDUCT

Athlete Medical Information