Florida Half Century Amateur Softball Association
Registration Application
08/19/2017
Registration Application


Full Legal Name
Permanent Home Address
City County State ZIP
Telephone Number
Date of Birth Birth Place (Country)
Birth City County State ZIP

Part Time Florida Residents complete this section
Months residing in Florida: From To
Address
City Country ZIP
Telephone Number (if different from above)

FHC Team Affiliation

Attach the following items to this application:
  1. $50 registration fee - Personal or Business Check / Money Order / Cashier's Check
    Payable to Florida Half Century ASA, Inc.
  2. Date of Birth Verification - Birth Certificate / Birth Registration / Baptismal Certificate / Passport
    Originals will be returned
  3. Government issued Picture ID - Copy of front and back of Driver's License or ID
    Address needs to match permanent address above
  4. Waiver and Release of Liability Form - Signed and dated

VOLUNTARY DISCLOSURE CONSENT: I hereby certify that the above information is correct and I further agree that the information may be verified through direct contact with the records bureau at the location of my birth or through the U.S. Immigration and the Naturalization Service. Falsification of documentation shall result in denial of membership.

Date   Signature of Applicant
Type or print legibly. Mail this application WITH the above 4 listed documents to:
Mike Knowles
3806 30th Lane E
Bradenton, FL 34208
941-725-0790
Florida Half Century Amateur Softball Association
Registration Application
08/19/2017
WAIVER AND RELEASE OF LIABILITY FORM



I acknowledge that softball or any sporting event is an extreme test of a person’s physical and mental limits and carries with it the potential of death, serious injury, or property loss.

I HEREBY ASSUME THE RISKS OF PARTICIPATION IN A SOFTBALL EVENT.

I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns:

a) I waive, release, and discharge from any and all claims of liability for death or personal injury or damages of any kind all representatives of the Florida Half Century Amateur Softball Association, Inc.

b) I agree not to sue any representative of the Florida Half Century Amateur Softball Association, Inc. or the association for any claims or liabilities that I have waived, released, or discharged herein.

c) I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.

BY SIGNING THIS FORM, I AFFIRM THAT I AM FIFTY (50) YEARS OF AGE, OR WILL ATTAIN THAT AGE DURING THIS CALENDAR YEAR, OR OLDER, AND THAT I WILL OBEY THE RULES, REGULATIONS AND BYLAWS OF THE ASSOCIATION. I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENTS.


Printed Name Date

  Signature of Applicant
PLEASE COMPLETELY FILL OUT THE ABOVE FORM LEGIBLY (Typing Preferred) AND MAIL TO:
Mike Knowles
3806 30th Lane E
Bradenton, FL 34208
941-725-0790

PLEASE COMPLETELY FILL OUT THE ABOVE FORM LEGIBLY (Typing Preferred) AND MAIL TO:
 
 
Mike Knowles
3806 30th Lane E
Bradenton, FL 34208
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