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D/LVMA United Dodgeball League

Registration Form

Player’s Name: _______________________________ Age: ______ D.O.B. _________

Height: _______ Weight: _______ Sex: Male Female Shirt Size: Sm Med. Lg. XL
Address:___________________________________ City: _______________________
State: _____ Zip: __________ Phone: _______________ Cell:__________________
Email: _________________________________________________________________
Parent/Guardian (if under 18) __________________________________________________
Emergency Contact Information:
Name: _______________________________ Phone: ___________________________
Name: _______________________________ Phone: ___________________________
How did you learn of LVMA/D.A.D.?__________________________________________
Age Group
____6-9 Yrs. ___10-14 Yrs.
Children 6-9 yrs. old will be playing at Fogelsville LVMA, all other matches will take place at Emmaus LVMA

Session & Teams

Each session will run for 10 weeks. Session begins on January 16, 2010. Games will be played on Sunday evenings
at LVMA Emmaus and LVMA Fogelsville. Each team will play 5 games per night. Each team will consist of no more
than 10 players.
Registration Fee: $20 per player League Fee: $50 per player
Each player will receive a league t-shirt to be worn to matches. Trophies and bounce party will be provided at
the end of each session.
I hereby give Lehigh Valley Martial Arts and the Dodgeballer’s Association of Dodgeball the absolute right and permission to
publish, copyright and use pictures and or video of me/my child in which I/we/he/she may be included in whole or in part, com-
posite or retouched in character or form, in conjunction with the advertising and promotion of Lehigh Valley Martial Arts and
Active Learning Centers or Dodgeballer’s Association of Dodgeball.

Refund Policy
Player or player’s legal guardian acknowledges that registration fees and player fees are non-refundable.

Player understands that participation in dodgeball involves physical exertion and contact. Player acknowledges that participation
in dodgeball is dangerous and that there is a risk of injury involved in the activity. Player agrees to waive any claim, and to re-
lease Lehigh Valley Martial Arts, Active Learning Centers, LLC, Dodgeballer’s Association of Dodgeball and its employees and
agents, from any claim for injuries sustained as a result of participation in dodgeball, including injuries claimed to have been
caused by the negligence of Lehigh Valley Martial Arts, Active Learning Centers, LLC, Dodgeballer’s Association of Dodgeball or
its agents and employees. This release and waiver does not apply to any act of willful misconduct or gross negligence.

Call 610-366-8084
Signature of Player or Legal Guardian
Ask for Susan