SPORT or SPECIAL EVENT:_____________________

CIRCLE: MALE / FEMALE / CO-ED

CIRCLE: COMPETITIVE / RECREATIONAL

TEAM CAPTAIN: ____________________________________PHONE NUMBER______________

The participants on this roster wish to participate in the intramural proram. Each member recognizes that any intramural activity has a degree of risk, and is knowingly and voluntarily assuming the risk of injuries, regardless of severity, including death, and all risk of damage to or property loss which may be incurred while participating. In consideration of the opportunity to participate, on behalf of self, heirs, and next of kin, those signed below release the University of Minnesota Morris, the UMM intramural program, and members and representatives from any responsibility or liabilty for personal injury, including death, and damage/loss of property incurred due to negligence of the above group or personal negligence while participating. In addition, by signing below, each individual is certifying that to their knowledge there is no medical reason why one cannot safely participate and agree to abide by all University of Minnesota Morris intramural regulations.

NAME_ _________SIGNATURE ________Phone____________Email_________

1.___________________________________________________________________

2.___________________________________________________________________

3.___________________________________________________________________

4.___________________________________________________________________

5.___________________________________________________________________

6.___________________________________________________________________

7.___________________________________________________________________

8.___________________________________________________________________

9.___________________________________________________________________

10.__________________________________________________________________

11.__________________________________________________________________

12.__________________________________________________________________

Please list below any time conflicts you team my have:_____________________________________

______________________________________________________________________________

**Please return entry forms to Student Activities before 4:00 p.m.
on registration deadline day with your team’s $10.00 forfeit fee
(which will be returned if you team does not forfeit any games)**