Summer Recreation Basketball Program ADULTS, 21+ YEARS 2023 SEASONPICK UP STYLE Adults, Ages 21 Dates: Wednesdays June 7 - July 19, 2023, 7:00-9:00 PMMust register by Friday June 1, 2023. Fee: No Fee in 2023 Name * Address * Town * Phone Number * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Email * Level of Experience * Beginner (little to no experience) Intermediate Advanced (Varsity/College) Signature * I, the undersigned, do hereby consent to my participation in voluntary or recreation programs of the Town of Sturbridge. I also agree to forever release the Town of Sturbridge, and all their employees, agents, board members, volunteers and any and all individuals and organizations assisting or participating in any voluntary or recreation programs of the Town (“the Releasees”) from any and all claims, rights of action that may have risen in the past, or may arise in the future, directly or indirectly, from personal injuries to myself or property damage resulting from my participation in the Town of Sturbridge voluntary activities or recreation programs. I also promise, to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injuries to myself or property damage resulting from participation in the Town of Sturbridge voluntary activities or recreation programs. I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form. I understand that my participation is voluntary and that I am free to choose not to participate in said programs. By signing this form, I affirm that I have decided to participate in the Town as a volunteer or in its recreation programs with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage that I may suffer in voluntary activities Sturbridge or recreation programs. Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Leave this field blank