Rockwell Collins PingPong League
- Registration Form -
= Required entry.
• To participate in Rockwell Collins Sports League activities, each registrant must comply with one of the following eligibility requirements: The individual must be a Rockwell Collins Employee or Spouse; an active Rockwell Collins Contractor or Spouse; a Rockwell Collins Retiree or Spouse; or currently a Member of the Rockwell Collins Recreation Center.
• Co-op Students are classified as employees.
• All active Rockwell Collins Contractors are eligible for Membership in the Recreation Center.
Employee, Fee: $10
Spouse of Employee, Fee: $10
Contractor, Fee: $10
Spouse of Contractor, Fee: $10
Retiree, Fee: $10
Spouse of Retiree, Fee: $10
Rec Center Member, only, Fee: $10
Are you also a member of the Rec. Center? Yes
Note: Non-Rec. Center Members will be charged a fee of $25, over-riding the above-mentioned fees.
Enter special requests etc.
Indemnity Agreement, Waiver and Release:
Rockwell Collins Recreation Center Acknowledgment of Assumption of Risk, Indemnity Agreement, Waiver and Release I, the undersigned, know and understand that the use of Rockwell Collins, Inc.’s ("RCI") Recreation Center, hereinafter referred to as "Recreation Center", and my participation in its related events for recreation, the improvement of fitness, and/or the improvement of athletic skills may: • Involve potentially hazardous or dangerous activities and conditions or • Cause me injury, including but not limited to: muscle sprains and strains, ligament tears, broken bones, back injuries or heart attacks, some of which may even cause paralysis or death. I attend the Recreation Center and its related events out of my own free will and choice. In choosing to use the Recreation Center or participate in its related events, I fully accept and assume the risk of injury, whether before, during, or after my use of the Recreation Center or participation in its events. This includes, without limitation, physical injury, mental injury, emotional distress, trauma, sickness, illness, death, contact with other participants, inadequate safety equipment, the effects of weather including extreme temperature or conditions, and negligence of others participating in the events, including those watching or observing. I am aware that the risk of injury or death is always present while exercising and that this risk cannot be eliminated by RCI or the Recreation Center’s managers or employees while using the Recreation Center or participating in its related events. All risks are known appreciated and assumed by me and I waive any and all specific notice of the existence of them and further waive the obligation, if any, that any other person or entity has to advise or warn me of them. I assume liability for and agree to pay my own medical and emergency expenses in the event of injury, illness, or other incapacity regardless of whether I authorized such expenses. I realize that the use of the Recreation Center and/or the participation in its related events may require physical conditioning. I represent that I am in sound medical condition capable of using the Recreation Center or participating in Recreation Center events without risk to myself or others. I have no medical impediment that would endanger others or me. I will be solely responsible for the condition and adequacy of my athletic equipment and safety gear. I will exercise safely within the limits of my own abilities, my equipment, the environmental conditions, and in a manner that does not endanger others or me. Knowing these facts and in consideration of my membership to the Recreation Center and/or use of the Recreation Center and participation in its related events, I for myself, spouse, children, heirs, next of kin, executors, administrators, assigns and anyone acting on my behalf, release, waive, discharge, covenant not to sue and agree to hold RCI and its subsidiaries and affiliated entities and its directors, officers, employees, representatives, agents, and successors; Match Play Tennis Centers, Inc. and its subsidiaries and affiliated entities and its directors, officers, employees, representatives, agents, and successors; Recreation Center event co-sponsors and volunteers harmless from any and all claims, demands and actions of any and every kind I have, may have or may hereafter accrue against the released parties directly or indirectly arising out of or relating in any respect to my attending or use of the Recreation Center and/or participation in any related events. My waiver and release of all claims, demands, actions and liabilities shall include without limitation, any personal injury, accident, illness or death and any property damage or loss that may be: (a) caused by any act, or failure to act, by the above-identified persons and entities, including without limitation, their negligence, errors, omissions in providing exercise advice or the failure to enforce rules and/or (b) sustained by me before, during or after the use of the Recreation Center and the participation in its related events. I acknowledge that I am signing this agreement freely and voluntarily, and intend by my signature for this to be a complete and unconditional release of all liability to the greatest extent allowed by law. I further acknowledge that no representations, promises, statements or inducements have been made to me other than as set forth in this document. I will abide by all Recreation Center rules and regulations. I further agree to indemnify and hold the parties released above harmless from any and all losses, damages, injuries, claims and expenses, including attorneys’ fees, arising from or relating in any respect to my use of and/or participation in Recreation Center and/or its related events or my breach of this agreement. If I am a minor, my parent or guardian also is signing on my behalf. We both agree to be bound by the terms of this agreement, waiver and release. I also waive all spousal claims relating to the Recreation Center, if any, that I hold or that may arise through me. I agree that no modifications or amendments to this waiver and release shall be binding unless they are accepted in a separate writing signed by the Senior Vice President of Human Resources for RCI. I have read the foregoing Recreation Center Acknowledgment of Assumption of Risk, Indemnity Agreement, Waiver and Release and have voluntarily executed this document with full knowledge of its content.
with the above text, and submit my "Signature".
December 14, 2017
Review & Submit:
Important… Review your email address!
Rockwell Collins Recreation Center, 800 Collins Road N.E., Cedar Rapids, Iowa 52498
Customer Service Phone Number:
If you feel that you have been charged in error, please contact Mike Duffy at 319-295-2552 and if indeed there was an error, you will be refunded the full amount directly back to the card that you used for the transaction you are referencing.
Your personal information including your credit card information will not be shared with any other private party and is only used for the purposes of completing this transaction. Your card number is secure and not visible to anyone on staff.
Larry Tjaden 319-365-8160 firstname.lastname@example.org
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