Annandale Sports Club Registration Form 
First Name 

Last Name

DOB

Gender
Address
Street 1
Street 2

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E-Mail 

Alt. E-Mail 

Home Phone

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Emergency Contact Information 

Emergency Contact 

Phone Number 

Insurance Company

List any Medical Problems or N/A





Volunteers Needed

Volunteer 
IMPORTANT POLICY INFORMATION

*Read the following information and check the box to indicate your agreement. 

ANNANDALE SPORTS CLUB ADULT PLAYER RELEASE AND WAIVER I hereby attest that I am fully cognizant of the risks involved in any/all of the Annandale Sports Club athletic sports and voluntarily assume the same, and agree to abide by the published rules of Annandale Sports Club, at all times during my participation in Annandale Sports. I further attest that I do not suffer from any heart, lung or other medical condition or disease that might in any way hinder or prevent me from fully participating in Annandale Sports or make me more susceptible to injury or harm while playing any of the sports. In consideration of received permission to participate in Annandale Sports: (A) I hereby release, discharge and hold harmless Annandale Sports and its officers, directors, employees, members, subsidiaries, agents, successors, managers, volunteers, assigns, and any party named as an additional insured on any policy of insurance held by any of the foregoing parties, or other parties which Annandale Sports has or may be obligated to indemnify, hold harmless or to which Annandale Sports may otherwise be liable, including but not limited to all governmental or private entities which lease, rent or permit use of premises for play, recreation, pre or post game activities (collectively, the Released Parties), from any and all liability that may arise directly or indirectly at any time, by reason of any injury, death, damage, loss, or expense incurred in connection with (i) my participation in any of the Annandale Sports sports, or (ii) my attendance at any social or charitable event or gathering that may be organized, authorized, or paid for by the Released Parties, individual Annandale Sports players, or any league or division organized under the Released Parties or their rules, including but not limited to happy hours, bar functions, and any pre-game or post-game events or gatherings; and (B) I fully authorize Annandale Sports, its subsidiaries and affiliates to use my name, likeness or image for purposes of advertising, marketing, promotion or trade without further compensation, except where prohibited by law; and I further acknowledge and agree that any images or recordings obtained or procured by Annandale Sports shall be the sole and exclusive property of Annandale Sports, and may be published, broadcast or otherwise disseminated at the sole and exclusive discretion of Annandale Sports. This Player Release Waiver shall be binding on my heirs, executors, administrators, successors, and assigns, and the releases and waivers contained herein shall include damages, losses or injuries that may be caused solely or in part by the fault (including but not limited to negligence, gross negligence and/or recklessness) of the Released Parties. In simple terms, you will not be able to sue or hold liable Annandale Sports and/or its officers, directors, employees, members, subsidiaries, agents, successors, managers, and volunteers for anything! You will play and participate at your own risk!


I HAVE READ AND UNDERSTOOD THIS PLAYER RELEASE WAIVER AND ENTER INTO IT VOLUNTARILY, IN CONSIDERATION OF THE OPPORTUNITY TO PARTICIPATE IN ANNANDALE SPORTS.


Name_________________________________________________Signature_____________________________________________________________________ 


Date-
Registration for Basketball Spring 2011 includes;
Annandale Sports Game team T-shirt
$5.50 County Fees for County Residents.

Non County residents must include a facility use fee of $30.00. Verification of residence will be required at the beginning of the season before the first game. 
 


County Residents  $110.00


Non County Residents  $140.00


Late Fee after 3/25/2011$25.00
After checking that your registration form is complete, please click on the submit button below.  You will be directed to on-line payment. ***** Please note your registration will not be complete until you complete the on-line payment portion and receive a registration confirmation or your registration payment has been processed by Annandale Sports Club.  If you are mailing your payment, please send payment to:

Registration 
Annandale Sports Club
P.O.Box 11144
Alexandria, VA 22312 
Required *
Select Annandale Sports Club T- Shirt Size