EmailMe Form - All Star Labor Classic Selected Player Information

Athlete's Name *

First Last

All Star Labor Classic Team *

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Athlete's Email *

Athlete's Phone *

### - ### - ####

T-Shirt Size *

High School Name *

Coach's Name *

First Last

Coach's Phone *

### - ### - ####

Coach's Email *

Parent/Guardian Contact Information

Contact information will only be used for communications regarding the 2014 All Star Labor Classic

Name *

First Last

Parent/Guardian Email *

Parent/Guardian Phone *

### - ### - ####

Publicity

Please provide the name(s) of your neighborhood newspaper(s):

Recognition Dinner

Athletes and their parents/coach are invited to a special dinner recognizing their achievements. This dinner will be held on Tuesday, March 24, 2015, 5:30 pm, at The Sprinkler Fitters Local 692 Union Hall (14002 McNulty Road, Philadelphia).

There is no charge for this dinner. However, space is limited. Please limit your RSVP to 3 guests (ex: 1 player, 2 parents/guardians or 1 player, 1 parent/guardian, 1 coach).

Total number of attendees *

1

2

3

Will not attend

Committment to Play

I commit to play in the 2015 All Star Labor Classic on Sunday, March 29, 2015 at New Foundations Charter High School. *

Yes

No

Waiver

In consideration of your acceptance of this entry and granting permission for my participation in this event, I hereby intend to be legally bound, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may now or hereafter have against United Cerebral Palsy of Philadelphia & Vicinity, Philadelphia’s Organized Labor, Northeast High School, The School District of Philadelphia, and any sponsors, coordinating groups and individuals associated with the event, their representatives, successors and assignees, and will hold them harmless from any injuries or damages which I may suffer in this event.

None of the above are responsible for the loss of personal items or other forms of aggravation in connection with this event. I have been warned that I must be in good health to participate in this event and I attest that a licensed physician has verified my good physical condition.

I hereby grant United Cerebral Palsy (UCP) of Philadelphia & Vicinity permission for the unlimited usage of my voice, image, portrait, photograph, in all forms and media for any purpose which will be of value to UCP or to people with disabilities, including publicity, the internet and fundraising. I waive any right to inspect or approve the finished piece therewith, in consideration of what has been agreed upon and acknowledged.

By accepting this waiver you are indicating you are 18 years or older. If you are younger than 18, you are indicating that you have the consent of a parent or legal guardian to participate.

I have read and understand the above waiver and agree to its terms and conditions. *

Yes

No