Registration Form

North Coast Puerto Plata, Dominican Republic

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TEAM/COACH/PLAYER/BYSTANDER

COVID-19 FORM

HAVE YOU EXPERIENCED ANY OF THE FOLLOWING SYMPTOMS WITHIN THE LAST 14 DAYS?

Fever (100.4 Fahrenheit, 37.8 Celsius)
Sore Throat
Chills
Congestion or Runny Nose
Cough
Nausea or vomiting
Shortness of breath
Diarrhea
Muscle or Body Aches
Are You Feeling Sick Today?
DU Fatigue
Have you had contact with someone recently diagnosed with Covid-19 in the last 14 days?
Headache
New Loss of Taste or Smell
Have you been asked to self-isolate or quarantine by a medical professional in the last 14 days?

By signing this, I attest that the above information is truthful and accurate.

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REGISTRATION FORM

CONTACT INFORMATION

Ernest Fair, Jr.
President, Serenity Youth Development, Inc.
(631) 523-8559
[email protected]

Ernest Fair III
Director, Serenity Youth Development, Inc.
(631) 416-1333
[email protected]

How Many Players Will Your Team Have? (Circle one)
How Many Assistant Will Your Team Have? (Circle one)

Please give the names of all Assistant Coaches below:

TEAM FAMILY & FRIENDS

REGISTRATION FORM

CONTACT INFORMATION

Ernest Fair, Jr.
President, Serenity Youth Development, Inc.
(631) 523-8559
[email protected]

Ernest Fair III
Director, Serenity Youth Development, Inc.
(631) 416-1333
[email protected]

Traveling By Yourself? (Circle one)
Have any Children Under 2 Joining you? (Circle one)

Below, Please enter the all the information needed for any additional guests:

Is this guest address the same as the one above?

Children 17 and Under information

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TEAM/COACH/PLAYER

EMERGENCY CONTACT FORM

***Each member of the team participating in any capacity must complete this form.

MEDICAL INSURANCE INFORMATION
EMERGENCY CONTACT INFORMATION
Do you give permission to Serenity Lifestyle Development Inc. to share details about current medical status and updates with the selected parties above? (Circle one)
IDENTIFICATION VERIFICATION
Are you 18 yrs and older? (Circle One)
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Step 1 of 2

TEAM/COACH/PLAYER
RELEASE OF LIABILITY AND HOLD HARMLESS

WAIVER FORM

Part I
IN CONSIDERATION OF THE RISK OF INJURY THAT EXISTS WHEN PARTICIPATING IN THE NORTH COAST BASEBALL SHOWCASE IN PUERTO PLATA (HEREINAFTER, THE "ACTIVITY") AND IN CONSIDERATION OF MY DESIRE TO PARTICIPATE IN THE ACTIVITY, I ACKNOWLEDGE THAT I HAVE THE RIGHT TO PARTICIPATE IN THE ACTIVITY.
I, MY HEIRS, THE EXECUTORS, ADMINISTRATORS, ASSIGNEES, OR PERSONAL REPRESENTATIVES (HEREINAFTER COLLECTIVE, "RELEASE" OR "T", WHICH TERMS WILL ALSO INCLUDE THE PARENTS OR GUARDIANS OF THE RELEASER IF THE RELEASER IS UNDER 18 YEARS OF AGE), HEREBY KNOWINGLY AND ENTERING VOLUNTARILY IN THIS EXEMPTION, RELEASE OF LIABILITY AND HOLD HARMLESS, HEREBY WAIVE EACH AND EVERY ONE OF THE RIGHTS, CLAIMS OR CAUSES OF ACTION OF ANY KIND ARISING FROM MY PARTICIPATION IN THE ACTIVITY;
I HEREBY RELEASE AND DISCHARGE FOREVER LIFESTYLE HOLIDAYS HOTELS AND RESORTS, PUERTO PLATA ALLSTARS, CHAIRMAN'S CIRCLE, SERENITY YOUTH DEVELOPMENT, SERENITY LIFESTYLE, THE EAGLEBROOK SCHOOL, EDWARD ALAN BIG & TALL, LONG ISLAND ATHLETICS, AARON LOPEZ, JONATHAN WHITE, VICTOR SEARCY, JARED MURPHY, LA BATERA BATTING CLUB, NORTH COAST YOUTH BASEBALL SHOWCASE, RAMON RAMIREZ BASEBALL ACADEMY, DYCKMAN BASKETBALL, PADRE GRANERO BASKETBALL AND CULTURAL CLUB, ROCHESTER NEW YORK SISTER CITIES, NORTH COAST BASKETBALL, OMEGA PSI PHI, INC., ALPHA KAPPA ALPHA, INC., ITS AFFILIATES, CHAPTERS, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS (COLLECTIVELY "RELEASED"), FROM ANY PHYSICAL OR PSYCHOLOGICAL INJURY I MAY SUFFER AS A DIRECT CONSEQUENCE OF MY PARTICIPATION IN THE AFOREMENTIONED ACTIVITY.
I VOLUNTARILY PARTICIPATE IN THE ACTIVITY MENTIONED ABOVE AND I PARTICIPATE IN THE ACTIVITY TOTALLY AT MY OWN RISK. I AM FULLY AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY WHICH MAY INCLUDE BUT ARE NOT LIMITED TO: TEMPORARY, PERMANENT, OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS AND DISFIGURATION, AND EMERGING DISABILITY. I UNDERSTAND THAT THESE INJURIES OR RESULTS MAY BE CAUSED BY NEGLIGENCE BY ME OR OTHER, CONDITIONS AT THE SITE OF ACTIVITY. HOWEVER, I ASSUME ALL RELATED RISKS, KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.
FURTHER, I AGREE TO INDEMNIFY, DEFEND, WAIVE AND HOLD HARMLESS AGAINST ANY AND ALL CLAIMS, DEMANDS, OR ACTIONS OF ANY KIND FOR LIABILITY, DAMAGES, COMPENSATION, OR OTHERWISE BROUGHT BY ME OR ANYONE ON MY BEHALF, INCLUDING FEES OF ATTORNEYS AND ANY RELATED COSTS.
I ACKNOWLEDGE THAT THE RELEASED ARE NOT RESPONSIBLE FOR THE ERRORS, OMISSIONS, ACTS, OR PERFORMANCE FAILURES OF ANY PARTY OR ENTITY CONDUCTING A SPECIFIC EVENT OR ACTIVITY ON BEHALF OF THE RELEASED. IN THE EVENT THAT MEDICAL ATTENTION OR TREATMENT IS REQUIRED,

TO PROVIDE ALL EMERGENCY MEDICAL CARE DEEMED NECESSARY, INCLUDING, BUT NOT LIMITED TO, FIRST AID, CARDIOPULMONARY RESUSCITATION, USE OF AEDS, EMERGENCY MEDICAL TRANSPORTATION, AND EXCHANGE OF MEDICAL INFORMATION WITH MEDICAL PERSONNEL. IN ADDITION, I AGREE TO PAY ALL COSTS INVOLVED AND AGREE TO BE FINANCIALLY RESPONSIBLE FOR ANY COSTS INCURRED AS A RESULT OF SUCH TREATMENT. IAM AWARE AND UNDERSTAND THAT I MUST HAVE MY OWN INSURANCE.