Adult Athletics

Please complete the following documents as soon as possible. Once complete, you will receive an email confirmation from your coach with additional information including any meetings, practices, and any fees (if applicable).

If you do not receive an email or have any questions, you can email Athletics@Sainttherese.net.

1. Player Information (Needs to be completed for each season being played)
2. Adult Hold Harmless from the Diocese of Charlotte (This only needs to be completed once)

PART 1: PLAYER INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Birthday REQUIRED Please fill out this field. Please enter a date.

Home Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship Please enter valid data.

Which sport are you interested in playing (check all that apply)? REQUIRED Women's Spring Softball Men's Spring Softball Men's Fall Softball Co-Ed Fall Softball Pickleball Men's Basketball Women's Basketball Bowling Please fill out this field.

Please choose your shirt size below:

Men's Shirt Size

Women's Shirt

PART 2: ROMAN CATHOLIC DIOCESE OF CHARLOTTE ADULT HOLD HARMLESS / INDEMNITY AGREEMENT
(Return Completed Form to Parish/School/Agency)

ACTIVITY: Athletics
DATE AND LOCATION: Mooresville or Huntersville, North Carolina
PARISH/SCHOOL/AGENCY: Saint Therese Catholic Church
I wish to participate in the activity described above, and as a condition of my being allowed to do so, I, hereby, release and discharge the Diocese of Charlotte, its constituent organizations, including but not limited to said Parish/School/Agency and their officers, agents, and employees, from any and all rights and/or claims I may have or hereafter acquire, for personal injuries, property damage or other, that I may suffer as a result of my participation in the activity described above, whether or not such injuries or damage are caused by the negligence (active or passive), of any of the entities or individuals named or described above.

I, hereby, warrant and represent that I am physically fit and capable of taking part in such activity. I make this warranty and representation on the basis of advice given me by a duly licensed medical doctor within the last six months, and I know of no change in my medical condition since receiving such advice that would affect the opinion of said medical doctor.

I agree to abide by the rules and regulations governing the above described activity and to obey any instructions given by the person or persons having supervision and control over the activity.

Photo Release
I, and on behalf of my family, heirs, and assigns, hereby grant to the Parish/School/Agency and/or The Roman Catholic Diocese of Charlotte herein referred to collectively as the “Diocese”, permission to record on photography film and/or video, whether digital or otherwise, pictures, images and/or reproductions of my participation and/or my families participation in this activity. I agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, social media, internet or other printed materials that the Diocese deems to be an appropriate use, and further that such use shall be without payment of fees, royalties, special credit or other compensation. I agree to indemnify and hold harmless the Diocese, its agents, representatives and assigns from any and all claims regarding the use of said material. Furthermore, I hereby waive any and all claims that I may have, or hereafter acquire, regarding the use of said material by the Diocese, its agents, representatives and assigns. This release shall not expire unless revoked by me in writing.

In the event that I should require medical treatment and I am not able to communicate my desires to attending physicians or other medical personnel, I give permission for the necessary emergency treatment to be administered.

I warrant and represent that I am eighteen years of age, or over, and upon request will produce satisfactory proof of such fact.

Check to indicate agreement.

I Agree Please select this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date Electronically Signed REQUIRED Please fill out this field. Please enter a date.

*If you are a current employee of Saint Therese or the Diocese of Charlotte, please complete the section below. All others please leave this section blank.

My participation in this activity will be conducted on my own time and not on my time as an employee of Saint Therese or the Diocese of Charlotte. Further, this participation on my part is for my own personal benefit, is voluntary on my part, and is not as a result of any suggestion or direction of my said employer or anyone acting on its behalf. I am fully aware that any injury I may incur as a result of such participation will not be considered as a work-incurred injury, or one arising out of or in the course and scope of my employment.

First Name Please enter valid data.

Last Name Please enter valid data.

Date Electronically Signed Please enter a date.

Check to indicate agreement. I Agree

St. Therese Catholic Church

217 Brawley School Road, Mooresville, NC 28117

Adult Athletics

adult athletics at st. therese

COACH CORNER

FALL 2022: ADULT SOFTBALL FOR MEN AND CO-ED

adult athletics and indemnity agreement

pickleball