Session 4 July 7 - July 11, 2014 Time 8:15AM to 9:00AM
Personal Information

First Name: Last Name:

Gender:    Email Address:

Retype Email Address:

Address (Number and Street):

City:  State:    Zip:

Home phone: Date of Birth:

Current School: Grade:  T-Shirt Size:
Medical Information

Emergency contact: Relationship:
Phone:   Cell Phone:
Address (if other than above):
Family Doctor: Phone:
Physical Condition:


I hereby elect voluntarily and on my own initiative to participate in the Yale Community Rowing Programs at Yale University. I acknowledge that the full responsibility for any personal injury or illness, accident, risk or loss, or property damage that may be sustained by me as a result of being engaged in these activities is mine. In particular, I acknowledge and am fully aware of the risk and hazards associated with athletic activities.
I acknowledge that the Yale Community Rowing Program, the Yale Athletic Department and Yale University shall not be responsible for any illness, injury or accident, damage or loss suffered by  me from or in connection with my participation in the above-mentioned athletic activities, and hereby release and agree to hold harmless the Yale Community Rowing Program, the Yale Athletic Department and Yale University and its officers, directors, employees and agents from liability, claims, demands, and actions arising out of or related to any loss, property damage, illness, injury or accident that may be sustained by me in the above-mentioned athletic activities.
I further acknowledge that I have adequate health and accident insurance.
This release and hold harmless agreement is binding on myself, heirs, assigns and personal representatives.
I have read and agree to the terms above

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