Register for DodgeBRAWL 2019 Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*T-Shirt Size*SmallMediumLargeExtra LargeTeam NameType of Player*Select oneCorporate or CommunityCollegeCorporate Player Price: $75.00 Quantity: Use this option to sign up as a playerCorporate Team Entry Price: $600.00 Quantity: Use this option if you are paying for a whole teamCollege Player Price: $25.00 Quantity: Use this option if you are a college playerCollege Team Price: $200.00 Quantity: Use this option if you are paying for a whole teamIf you signed up an entire team, please enter names of team members below:Buy a Life Price: $25.00 Quantity: Each player can buy one "Life" to use to get back in the game should you be eliminated. Additional "Lives" can be purchased on game day at the tournament.I would like to make a donation to Jeremiah School Total Due $0.00 WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISKS Please read this information carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you might sustain as a result of participating in any and all activities connected with and associated with this program/activity. I recognize and acknowledge that there are certain risks of physical injury to participants in this program, and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of the severity, that I may sustain as a result of participating in any and all activities connected with or associated with this program/activity. I further agree to waive and relinquish all claims as a result of participating in this program/activity against Jeremiah School, and their members, advisors, volunteers, board members, sponsors and administrators. I do hereby fully release and forever discharge Jeremiah School and their members, advisors, volunteers, board members, sponsors and administrators from any and all claims for injuries, damages or loss that I may have, or which may accrue to me and arising out of, connecting with, or in any way associated with this program/activity. Waiver Acknowledgment* I hereby acknowledge that I have read, understand and agree to comply with the provisions of this Release and Waiver relating to my participation in this event. This iframe contains the logic required to handle Ajax powered Gravity Forms.