USSSA & WASHINGTON STATE AMATEUR ATHLETIC WAIVER/RELEASE OF LIABILITY & ROSTER
(ANNUAL FEES: YOUTH SLOW PITCH TEAMS $6.00/////YOUTH FAST PITCH TEAMS  $25.00)
Complete the items and mail to:  USSSA WASHINGTON STATE, P.O. BOX 31089, SEATTLE, WA  98103
Ph: (206) 789-9133   FAX: (206) 789-1659   Web: http://www.usssawa.com   Email: Stateoffice@usssawa.com

TEAM NAME: __________________________________________________________ Name Last Season: _________________________________
                                        (Limit to 29 Characters with spaces)
Manager’s Name: _______________________________________________________________ Home Ph:  (_____)___________________________
Address: ______________________________________________________________________ Cell Ph:  (_____)_____________________________
City: ________________________________________________________________ State: _________________ Zip:  _________________________
League’s Name: _____________________________ City of League: ___________________ E-Mail: ______________________________________ Program:  __YOUTH________FP_______SP,       Age Group: ____________________       Classification Level: ___________________________.
PLEASE READ BEFORE SIGNING:  In consideration of being allowed to participate in any way in the UNITED STATES SPECIALTY SPORTS ASSOCIATION (USSSA) and USSSA WASHINGTON STATE DIVISION athletic/ sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
The risk of injury from the activities involved in the program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
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; and,
I willingly agree to comply with the stated and customary terms and conditions for participation.  If however 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; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS THE UNITED STATES SPECIALTY SPORTS ASSOCIATION (USSSA) and USSSA WASHINGTON STATE DIVISION, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (‘Releasees’), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
    I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND
ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
FOR PARTICIPANTS UNDER AGE 18 AT TIME OF REGISTRATION: This is to certify that I, as parent with legal responsibility for this participant, do consent and agree to his/her release as provided above all of the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE.
ALL PARTICIPANTS MUST READ AND SIGN THIS WAIVER AND RELEASE OF LIABILITY
TYPE OR PRINT NAME                                                                YOUTH DOB                                                   SIGNATURE/YOUTH PARENT                                               
                         
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TEAM MANAGER’S AFFIDAVIT: THIS IS TO CERTIFY THAT THIS ROSTER DOES NOT INCLUDE ANY ASSUMED NAMES AND THAT EACH PLAYER AND MIXED CLASSIFICATION CONFORMS TO THE ELIGIBILITY RULES GOVERNING U.S.S.S.A. SOFTBALL.


MANAGER’S SIGNATURE:    _______________________________________________________________ DATE: ____________________________________________


USSSA WASHINGTON STATE                                                                                     YOUTH SP/FP                                                                                             WSR-1y-10


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