UCSSL 2021 REGISTRATION
“Lets Play Ball and Have Some Fun”
PLEASE PRINT CLEARLY:
Last Name: ________________________________ First Name: _____________________________
Street Address: _________________________________________________________________________
City or Town: __________________________________________ Zip Code: _________________
Home Phone: ________________________________ Uniform shirt size: ______ number: _______
Email address: _________________________________________________________________________
Would you like to receive league communications at this email address in 2021? YES NO (Circle One)
Date of Birth: __________________________________ Age on
1. Have you participated in the UCSSL previously? YES NO (Circle One)
2. If you answered YES above, for how many consecutive years? ___________
3. Are you currently assigned to a team(s)? If so, what team?
(50’s) ________________________________ (60’s) _________________________________
** NOTE: all NEW players must submit a photocopy of both sides of their driver’s license **
Cost for membership in the UCSSL (per team) ……………………....……............. $ 80.00
Reduced (one year only) cost for players who paid the full 2020 UCSSL fee …… $ 55.00
All players: Please carefully read the following, and sign where indicated.
STATEMENT OF DISCHARGE OF LIABILITY
I am fully aware of the inherent risks and hazards in connection with my participation in any UCSSL games, including illness, disability and deaths. I understand that this risk includes the exposure to or contraction of communicable diseases including COVID-19. I acknowledge that I am increasing my risk of exposure to COVID by participating in UCSSL games, practices and meetings. I voluntarily assume the risk of any injury or illness, regardless of the severity including death that I may incur as a result of my participation. I understand that the assumption of risk includes, without limitation, risks associated with maintenance of fields, accessories and equipment. I recognize that I am solely responsible for my decision to participate in UCSSL games. If I choose not to have a vaccine before the season or at any time after it becomes available, I do so with the understanding that I assume all risks involved with that decision.
I agree to abide by all rules and regulations set forth by the Center for Disease Control (CDC), State of New Jersey Department of Health and UCSSL related to coronavirus and other communicable diseases.
I understand that if I travel outside the State of
I sign this form as my Voluntary Act and by this act I agree to exclude the Union County Senior Softball League and all of its officers and League officials from any claims, suits or other actions arising from, caused by, or which are the alleged result of any Act or omission by the League. I agree to participate in League play in the Union County Senior Softball League at my own risk and any injuries which I may incur will be paid for through my own personal medical plan or from my own personal funds.
This statement remains in effect as long as I participate in the Union County Senior Softball League or until I submit a written request to void this Statement of Discharge of Liability. I hereby certify that the above information is correct, and I realize that I am liable to be banned from UCSSL for life if the information is found to be false.
LEGAL SIGNATURE: ____________________________________ DATE:__________________
Return completed form, with payment to UCSSL (and copies of license if you are new to the league),