Intramural Registration Form - PVAMU Home

Intramural Registration Form

Please choose one from each group:
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Team Sports:
(NO MEMBERSHIP REQUIRED)

Fall Semester Spring Semester Summer Session 1 & 2
__ 3 on 3 Basketball __ 5 on 5 Basketball ___ Co-Rec Softball
__ 5 on 5 Co-Rec Basketball __Racquetball Clinic ___ Dodgeball

__ 7 on 7 Flag Football __ Racquetball ___ Volleyball
__ 5 on 5 Indoor Soccer __ 5 on 5 Men Basketball
__ 4 on 4 Volleyball __ 5 on 5 Women Basketball
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Division: __ Co-Rec __ Men __ Women
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League: __Open __ Res-Hall __ Greek __ Community/Faculty& Staff

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Skill Level: ___Play for Fun & Health __Competitive…Losing is not an option!
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Game Times: may range from those shown below. . .

Day Preference: (prioritize days 1 being most preferred, 2 next preferred, and so on. . . )
Monday Tuesday Wednesday Thursday Saturday Sunday

These are strictly preferences. . . no guarantees can be made!
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Team Name:____________________________________________
I agree to manage this team during the 200__-200__school year. I further agree to comply with all policies & procedures
set forth by PVAMU, Rec Sports, and the Intramural Sports program.

Captain Name Phone Number Email

Payment Information: J#

CAPTAINS MUST COMPLETE TEAM ROSTER ONLY!

Date Deposit Paid OFFICE USE ONLY Captain's Mtg. Attended
Received Cash
SuperCard# Staff Signature
Charge

Revised:6/1/2011

TEAM ROSTER: CAPTAINS MUST COMPLETE TEAM ROSTER ONLY!

PLEASE PRINT ALL INFORMATION CLEARLY!

Name Email Phone PVAMU ID#

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Revised:6/1/2011

Intramural Team Roster/Waiver Form

Every Play Must Complete This Page!

Team Name:

Assumption of Risk, Waiver, and Release from Liability

In consideration of the use of the property, facilities and/or services of the Intramural Sports Program, including any
travel related thereto, the undersigned agrees as follows:
1. Risk Factors- The undersigned understands and acknowledges that the use of equipment and facilities provided by

the Rec Sports at Prairie View A&M University and participation in Rec Sports programs (i.e., Intramural Sports)
involves risk such as, but not limited to the following: risk of property damage, bodily injury, and possible death.
These risks may result from the use of the equipment or facilities, from the activity itself, from the acts of others,
organization of an act or from the unavailability of emergency medical care.
2. Assumption of Risk- The undersigned assumes all risks which are foreseeable and involved with or arise out of the
equipment or facilities, the activity itself, the acts of others, omission of an act or the unavailability of emergency
care, including but not limited to those risks factors described in Section 1 above. Exception being injuries caused by
the sole or gross negligence, or willful or wanton misconduct on behalf of any officials, officers, employees, agents, or
volunteers of JSU.
3. Acknowledgement of Policies and Procedures- The undersigned acknowledges reading and knowing all policies
and procedures relating to the activities, facilities, and/or equipment and understands that the safe and proper use of
facilities, equipment or participation in the activity is dependent upon carefully following such policies and procedures.
4. Release- The undersigned releases PVAMU, Recreation Sports, and all of their officers, trustees, employees, and
agents not to initiate litigation on account of or in conjunction with any claims, causes of action, injuries, damage,
cost of expenses arising out of the activity, including those based on death, bodily injury, or property damage
whether or not caused by negligence or other fault of the parties being released.
5. Waiver- The undersigned waives the protection afforded by any statute or law in any jurisdiction whose purpose,
substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise which
the person giving the release does not know or suspect to exist at the time of executing the release. This means, in
part, that the undersigned is releasing unknown future claims.
6. Consent for Emergency Treatment- The undersigned, as a participant in the subject activity, hereby consents to
medical treatment in a medical emergency where the undersigned is unable to consent to such treatment.
7. Insurance- The undersigned understands the Rec Sports does not carry participant insurance. The undersigned is
encouraged to have a medical physical examination and purchase health insurance prior to any and all participation.
8. Acknowledgement- The undersigned has read and understands this agreement and realize it relates to
surrendering and releasing valuable legal rights and does so freely and voluntarily.

PLEASE PRINT ALL INFORMATION CLEARLY!

Name Email Phone Classification Signature

Date Received PVAMU ID# OFFICE USE ONLY Verifying Staff Signature

Deposit Paid

Cash
Charge

Revised:6/1/2011