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2017 THE GAME OF DREAMS PLAYER
REGISTRATION FORM
WHO: WE WANT YOU!!!!!!!!! We are looking for players for an upcoming charity softball event
that are interested in FUN, friendship opportunities, team building, and collective community
experience.
WHAT: The Game of Dreams is a charitable softball event in partnership with the Miracle
League of Ottawa, our goals are to increase awareness, exposure, funding, and community
involvement for the agencies mission. Prizes and raffles will be planned.
WHEN: October 21st 2017 at 11AM to 2PM Bring your ball gloves!!!! Guaranteed at least 2
games
WHERE: Ryan Farm Park, 5 Parkglenn Dr Nepean, K2G 3H1. Located across from Algonquin
College
Participant Registration
Name: __________________________________________________
Date of Birth:___________________________Gender:____________________
E-mail address (required): __________________________________________
Address: _________________________________________________________
City: ____________________________________
Prov: ________ Postal Code: _______________
Phone (day): _________________________ Evening: _______________________
Players Signature: ________________________________________________
Emergency Contact Info:
Emergency Contact Name:____________________________________________
Emergency Contact Phone #: Cell:_________________ Home:______________
Emergency Contact Email: ____________________________________________
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Process of Registration:
Fill out registration form and read/sign accompanying liability/waiver form
Return completed form to Matthew Cybulski in person or via email; Cell Phone: 613-601-8181
Email: cybu0071@[Link]
Pay required registration fee of $5 to Matthew Cybulski at time of registry or at start of The Game
of Dreams.
Cash Payment to Game of Dreams Development Department
ATTN: Matthew Cybulski/ Miracle Workers group staff
3659 Navan Rd, Miracle League Field
Orleans, Ont
Deadline: Thursday October, 19 2017 at 9PM, if space is available. No refunds will be given
after this date. ******************************************************
OFFICE USE ONLY
___ Completed registration form
___ Entry fee
___ Official League or Tournament roster spot accepted by staff ___________
Liability Waiver Form
To the best of my knowledge, I am in good physical condition and fully able to participate in this
event. I am fully aware of the risks and hazards connected with the participation in this event,
including physical injury or even death, and hereby elect to voluntarily participate in said event,
knowing that the associated physical activity may be hazardous to me and my property. I
VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY
DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or
loss or damage to property owned by me, as a result of participation in this activity.
I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Miracle Workers
Staffing, INC., their officers, servants, agents, and employees (hereinafter referred to as
RELEASEES) from any and all liability, claims, demands, actions and causes of action
whatsoever arising out of or related to any loss, damage, or injury, including death, that may be
sustained by me, or to any property belonging to me, while participating in physical activity, or
while on or upon the premises where the event is being conducted.
________________________________ Signature
_________________________________ Print Name
_________________________________ Date
_________________________________ Event
_____________________________________________________
Parents Signature Parents Print Name(If under 18)
