Intramural Sports team Registration Form                                                                    Office Use Only: ________________________________________

University of Hartford Intramurals


  Team Name:

        Choose one of the following Sports:                      Choose one of the following Division:                        Choose one of the following Term:


 Special Request for scheduling (This is not Guaranteed but we'll try our best to meet your needs):

 (Writing down No Thursday so you can go out is not an acceptable excuse!)


  Blackout Dates: (Dates and times that you are positive you cannot field a team. Accommodations are not guaranteed.)

  (Ex. Holidays, Special Events etc.)

  Day & Date       Event     Length of Event

  Day & Date       Event     Length of Event

This certifies that I, (team captain/ manger), know and understand the eligibility rules and have completely checked the eligibility of all the players on my team. If there is any discrepancy. I will assume full responsibility. I understand that failure to comply with these rules will result in action as outlined in the Intramural Handbook and the rule packets.         


 Team Captain Name:      Initial: 

 Local Phone   Date 

 Work Phone/ Cell Phone    SSN 

 Local/ School Address

 E-mail Address 


 Assistant Captain Name

 Local Phone 

 Work Phone/ Cell Phone   SSN

 Local/ School Address

 Email Address

This is not an assumption of risk form.

All players will be required to sign the assumption of risk form prior to participating in their first game.

Md. Moinuddin Ali.
Copyright 2006 [University of Hartford]. All rights reserved.
Revised: 10/07/06