DEARBORN HEIGHTS PARKS AND RECREATION 2013-2014 BASKETBALL INFORMATION SHEET TEAM REGISTRATION: September 30 - October 28, 2013

*****ENTRY FEES, ROSTERS, AND PHOTO IDs DUE BY 5:00 PM, OCTOBER 28. Registrations will be accepted at Richard A. Young Recreation Center and Canfield Community Center. MANAGER'S MEETING: TEAM ENTRY FEE: competition. DEPOSIT: A $50.00 deposit is required at the time of registration to hold your team's place in the league. This deposit will be used as your forfeit deposit for the season. If your team does not forfeit during the season, you will receive this $50.00 back. Richard A. Young Recreation Center, 5400 McKinley One game per week on Thursdays. Determined by single elimination tournament at the end of the regular season. Winner will represent Dearborn Heights at the annual MRPA Adult Basketball State Tournament. $20.00 per non-resident. Maximum of 8 non-residents per team. T.B.D. Location : Richard A. Young Recreation Center. $300.00 -- 12 Game Minimum; League limited to 8 teams. Teams may be split into two divisions based on level of

LOCATION OF GAMES: DAYS OF GAMES: LEAGUE CHAMPION:

NON-RESIDENT FEE:

SPECIAL NON-RES. FEE: $10.00 per special non-resident. A special non-resident is defined as a player whose parents still live in Dearborn Heights OR a player who works in Dearborn Heights. (PROOF OF EMPLOYMENT OR PARENTS RESIDENCY IS REQUIRED) UNIFORM RULES: height REFEREE FEE: game. STARTING DATE: INFORMATION: All leagues must have uniform shirts with numbers at least 6" in and no player may have the same number as a teammate. $25 per team per game. Must be paid prior to the start of the November 7, 2013 (313) 277-7080 or mhenegar@ci.dearborn-heights.mi.us

DEARBORN HEIGHTS PARKS AND RECREATION OFFICIAL ROSTER TEAM NAME NUMBER OF NON-RESIDENTS NUMBER OF SPECIAL NON-RES. LEAGUE: BASKETBALL MEN

CLASSIFICATION:

(Maximum 12 players - Maximum 8 Non-Residents)

PLAYER NAME 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. ADDRESS (CITY, ZIP) PHONE BIRTHDATE RESIDENT

TEAM MANAGER ADDRESS CITY HOME # E-MAIL CELL # ZIP

Amateur Athletic Player Waiver, Release of Liability & Indemnification Agreement

I, the undersigned player, acknowledge, agree and understand that: 1. Voluntarily and of my own free will, I elect to participate as a member of the basketball team and league indicated below. 2. I understand that there are certain risks and hazards involved in participating in basketball that may result in injury or death to me or other players, including, but not limited to those hazards associated with weather conditions, playing conditions, equipment and other participants. 3. I understand that the very nature of the game of basketball is hazardous and risky, including, but not limited to, the acts of running, jumping, stretching, sliding, diving, and collisions with other players and with stationary objects, all of which can cause serious injury or death to me and to other players. Further, I the undersigned player, agree that in consideration for the right to play as a member of the team designated below and in consideration for permission to play on the courts and in the gymnasiums arranged for by the team or league: 1. I voluntarily elect to accept and assume all risks of injury incurred or suffered by me (a) while practicing or playing as a member of the team so designated, (b) while serving in a non-playing capacity as a team member during practice or play by other teams or by other players on my team, and (c) while on or upon the premises of any and all of the courts arranged for by my team or league for practice or play. 2. I release, discharge and agree not to sue the team and league designated below, the gym owners or other entity designated below, the City of Dearborn Heights, or their officers, agents, servants, associations, employees, or any person or entity connected with the team, league, gymnasium, or the City of Dearborn Heights for any claim, damages, costs or cause of action which I have or may in the future have as a result of injuries or damages sustained or incurred by me from whatever cause including but not limited to the negligence, breach of contract or wrongful conduct of the parties hereby released. NAME OF TEAM Dearborn Heights Parks & Recreation Adult Basketball NAME OF LEAGUE

I ACKNOWLEDGE THAT I HAVE READ AND THAT I UNDERSTAND EACH AND EVERY ONE OF THE ABOVE PROVISIONS IN THIS WAIVER, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT AND AGREE TO ABIDE BY THEM. NAME OF PLAYER (PRINT) SIGNATURE OF PLAYER DATE