KINGSPORT PARKS AND RECREATION

ADULT TEAM ROSTER / WAIVER AGREEMENT

Team Name Year

League Division

Coach Email Cell Phone

Shirt
PLAYER’S NAME
PLAYER’S SIGNATURE
(Print) Size ADDRESS PHONE # DATE
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Waiver and Hold Harmless Agreement
I hereby agree to play with the team above and promise to abide by all rules and regulations. In consideration for the City of Kingsport
providing recreational activities, I hereby release the City of Kingsport and its agents and employees from any and all liability, claims, or
demands that in any way arise out of my participation in these activities.

Photo & Video Policy: Please be aware that photos and videos may be taken to promote the services and facilities that our
City offers and become the City’s sole property. The City of Kingsport and the media may publish these photographs or air
these videos in printed publications, cable TV, and online on the City’s website and social media.

This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. I further
state that I have carefully read the foregoing release and know its contents, & I sign my name as my own free act.
Release Agreement
As the official responsible for certifying this roster, I attest that the listed players above are eligible to represent this church, company,
agency, and/or sponsor.

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Minister/Personnel Director (Print) Minister/Personnel Director Email Address

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Minister/Personnel Director (Signature) Minister/Personnel Director Phone Number