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The Satellite Scorpion

Alumni Football Classic


The ALUMNI FOOTBALL CLASSIC game is scheduled for Friday, April 30, 2010 @ 6:30pm at Satellite Stadium.
This event, sponsored by the Touchdown Club, serves as a fundraiser for SHS football and participation is open
to any Satellite High athlete who graduated in or before 2005. Now more than ever former Scorpions need to
show their support for a revitalized Satellite Football program. With that in mind, all alumni are invited to
participate whether it is on the playing field, volunteering, cheering your fellow graduates, or contributing a
donation.

Please note: any participant suspected of being under the influence on school grounds will be ejected
immediately, forfeit any fees paid, and banned from future participation.

REGISTRATION & RELEASE FROM RESPONSIBILITY FOR PARTICIPATION IN


INHERENTLY DANGEROUS ACTIVITY

NAME_________________________________________________________DOB_____________________ GRAD
YEAR_______________

ADDRESS_____________________________________________________________________________________________________
___

CITY________________________________________________________ STATE_______________
ZIP_____________________________

PHONE (_______)_______________________________E-
MAIL____________________________________________________________

Release executed on the ___________day of _____________________2010, by


______________________________________________
referred to as the Releaser shall upon acceptance of this completed registration/release and $50.00 fee shall
be considered for participation in the Alumni Classic Football game to be held on April 30, 2010 at Satellite
Stadium in Satellite Beach, FL. The Releaser, and any all personal representatives, heirs, and next of kin, shall
hereby indemnify, release, and covenants not to sue the Brevard County School Board, Satellite High School,
any and all sponsors, officials, volunteers, coaches, participants or their officers, directors or employees
referred to as the Releasee connected with the event from any and all equipment failure, liability whatsoever,
damage, and any claim or account of injury associated with this activity, whether caused by the negligence of
Releasee or while the Releaser is participating in any and all activities, practicing for, or competing in said
event. Furthermore, I hereby grant full permission for the organizers and sponsors to include pictures and
quotations from me in any legitimate accounts of and in promotion of said event.

**INSURANCE INFORMATION:

Policy ___________________________________________

Policy # __________________________________________

Releaser attests that he is physically fit, has sufficiently trained and possesses medical insurance for this
event.

Signature__________________________________________________ Date____________________________
Witness____________________________________________________ Date____________________________

Make checks payable to: Touchdown Club


Received: Check_________ Cash_________