Individual Registration

* Required Fields

First Name *

 

Last Name *

 

Street Address 1 *

 

Street Address 2

Parish *

 

Post Code *

 

Date of Birth *

YYYY
  

(Players under the age of 18 years must have this form completed by a parent or legal guardian)


Home Phone

Mobile

Email Address *

 

Team Names *

(Please enter any combination of mixed, mens or ladies as appropriate)

Mixed                        Mens                         Ladies

  

Declaration: I hereby declare that I have read and understood all of the FNB Touch Autumn League Rules and Regulations (the "Rules and Regulations"). I further declare that having read and understood the Rules and Regulations I acknowledge and agree to the provisions set out in Appendix 1 (Waiver, release of liability, assumption of risk and indemnity agreement) to the Rules and Regulations. Without prejudice to the provisions of Appendix 1 of the Rules and Regulations:

1) I understand the nature of the Activities (as defined in the Rules and Regulations) and accept that the Activities involve risks and dangers of serious bodily injury including permanent disability, blindness, paralysis and death.

2) I fully accept and assume all risks and all responsibilities for all losses, costs and damages incurred as a result of my participation in the Activities.

3) I hereby release, discharge, covenant not to sue and agree to hold harmless the Releasees (as defined in the Rules and Regulations) from all liability, claims, demands, losses, or damages.

4) I acknowledge that I have given up substantial rights by submitting this form and have completed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by the law of Guernsey.

I hereby accept the above declaration which applies to myself / or to whom I am parent or legal guardian.

If you do not wish to recieve information in relation to the Guernsey Touch Team and associated events please tick this box.