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Intramural Sports Team Registration Form

University of Hartford Intramurals

                   Office Use Only 


          Team Name    



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.)


This Certifies that I, (team captain/ Manager), 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         Signature 

                                                                                                                                                                                          (Type your initials as a Signature)

                        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   


               E-mail Address     


 ** This is not an assumption of risk form**

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