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Jacob's Chance 2019 Fall Sports and Inclusive Fitness and Health Registration

Playing Levels:

PEEWEES (ages 5-10 or K-5th Grade)  

JUNIORS (Ages 11-13 or 6th through 8th grade)

SENIORS (Ages 14+ or 9th grade and beyond)

 

FALL TENNIS 

Fee to Play $25.00

 SEPTEMBER 29

OCTOBER 6, 13, 20, 27

4:00 - 5:00 PM PEEWEES  & JUNIORS 

5:00 - 6:00 PM SENIORS 

AT BYRD PARK

600 SOUTH BLVD, RICHMOND, VA 2322

 

FALL FLAG FOOTBALL

Fee to Play $25.00

October 5, 12, 19, 26

November 2, 9

10:00 - 11:00 AM PEEWEES & JUNIORS

11:15 - 12:15 PM SENIORS

AT SCOR

1365 OVERBROOK RD, RICHMOND, VA 23230

 

INCLUSIVE FITNESS HEALTH WITH VCU KINESIOLOGY HEALTH SCIENCE DEPARTMENT

 Fee to Play $35.00

SUNDAYS, SEPTEMBER 22- NOVEMBER 10

3:00 - 4:00pm PEEWEES & JUNIORS

4:00 - 5:00pm SENIORS

AT SCOR

1365 OVERBROOK RD, RICHMOND VA 23220

 

Multi-athlete and Multi-sport discounts available

Parent or Guardian Information
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First Name
Last Name
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First Name
Last Name


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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Athlete Registration
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First Name
Last Name
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Check all that apply
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Please select one
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(mm/dd/yyyy)
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Please also describe any special accommodations or information we should know about your child.
2nd Athlete Registration
All athletes registered on this form should be from the same family and live at the same address. Please open a new form if this is not the case.

First Name
Last Name
Check all that apply
Please select one

(mm/dd/yyyy)

Please also describe any special accommodations or information we should know about your child.
3rd Athlete Registration

First Name
Last Name
Check all that apply
Please select one

(mm/dd/yyyy)

Please also describe any special accommodations or information we should know about your child.
Concussion Awareness
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WAIVER

In consideration of being allowed to participate in any way in the program, related events and

activities, and use of equipment, I the undersigned, acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in this program is significant, including the

potential for paralysis and death.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF

ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full

responsibility for my participation.

3. I willingly agree to comply with terms and conditions for participation. If I observe any

unusual significant hazard during my presence or participation, I will remove myself

from participation and bring such to the attention of the nearest official immediately.

4. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of

kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Host, it’s officers, officials,

agents, and/or employees, other participants, sponsors, advertisers, and if applicable,

owners and lessors of premises used to conduct the event (RELEASEES), from any and all

claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY

OR DEATH I may suffer, or loss or damage to a person or property, WHETHER ARISING

FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent

permitted by law.

Health Statement

I will notify Jacob’s Chance ownership or employees if I suffer from any medical or

health condition that may cause injury to myself, others, or may require emergency care

during my participation.

1365 Overbrook Rd,

Richmond, VA 23220

804-640-8109

info@jacobschance.org

Media Statement

By agreeing below, I hereby grant and convey to Jacob’s Chance all right, title and interest

in and to record my name, image, voice, or statements including any and all

photographic images and video or audio recordings made by Jacob’s Chance

Venue

The Venue of any dispute that may arise out of this agreement or otherwise between

the parties to which Jacob’s Chance or its agents is a party shall be either the Richmond

City, VA Justice Court, or the County or State Supreme Court in Richmond City, VA.

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Registration Fee
Please select the quantity of players you are registering for each program. If you are registering more than one player or one player for more than one sport, please select the discount to apply it to your fee. If you are interested in paying by check, you can mail the check to Jacob's Chance, 1385 Overbrook Road, Richmond VA 23220. If the registration fee promotes a financial hardship for you, please email Kate Mardigian to receive a fee waiver approval at info@jacobschance.com. Even if you are not paying at this time, please select ENTER PAYMENT to complete registration.
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