NCCA-Cricket is Electrifying! :: Registration form

Adults Registration Details		Youth Registration
First Name		Last Name
Nickname		Gender	Male Female
Street Address		City
State		Zip Code
Telephone		Emergency Telephone
Age		Birthdate
E-mail address		Employer
Years of Experience		Medical Insurance Carrier
BOWL	LEFT RIGHT	BAT	LEFT RIGHT
List your previous cricket experience if any:
Current injuries or minor physical limitations or other medical condition the NCCA should know about:

Disclaimer, Assumption of Risk and Waiver and Consent Agreements
I warrant and acknowledge that I am the parent or legal guardian of the player named on the reverse side of this application, a minor (“Player”), and on behalf of myself, Player and our heirs, assigns and next of kin, I hereby enter into the following agreements IN CONSIDERATION OF Player’s being able to participate in any way at practices, games or other activities (“EVENTS”) sanctioned by the Northern California Cricket Association (“NCCA”)DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: I acknowledge that participation in cricket necessarily involves travel, play in adverse field conditions, contact with considerable force, and risk of severe, permanent physical injury including bruises, scrapes, strained, sprained or torn muscles,tendons or ligaments, broken bones, dislocation of joints, concussion, brain damage, nerve and spinal cord injury, paralysis and death. I WILLINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS. I willingly and voluntarily agree to comply with the stated and customary terms and conditions for participation and, if Player or I observe any concern in Player's readiness for participation in the EVENTS, I will remove him/her from participation and bring such concern to the attention of the nearest official immediately and also of the regional commissioner as soon as possible thereafter. I HEREBY RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS, to the fullest extent permitted by law, NCCA, its players, employees, volunteers, officials, sponsors and other representatives and any and all owners, lessors, lessees or other persons or entities allowing,permitting or authorizing the use of facilities by NCCA and the agents, employees, officers and directors of said persons or entities (“RELEASEES”) from any and all claims, demands, costs,expenses and compensation arising out of or in any way related to an injury or other damage that may result to said participant or to members of my family or my household or individuals I invite or for whom I am otherwise responsible while participating in or present at any of the EVENTS, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I further acknowledge that NCCA is primarily administered by volunteers rather than paid professionals. I further acknowledge and accept that this Disclaimer, Assumption of Risk and Waiver is intended to be as broad and inclusive as permitted by the laws of the state in which we live and agree that if any portion of this Disclaimer, Assumption of Risk and Waiver is deemed to be invalid, the remainder will continue in full legal force and effect. ACKNOWLEDGEMENT AND CONSENT: I understand the terms of the Cricket Accident Insurance Plan available at http://ncalcricket.org/forms/accidentinsurance.htm, as the same may be amended from time to time,and either I have read and understand the terms or I will do so before permitting Player to participate.For both internal and external use, I acknowledge that NCCA may compile and use addresses cricket photographs of Player consistent with the NCCA Privacy Policy set forth at http://ncalcricket.org/forms/privacypolicy.htm as the same may be amended from time to time.
I Accept