Registering an Individual

Fields marked with an * are required.

Personal Information
Full Name*: (First and Last Name Only)
Local Address*:
City/State/Zip*:
Phone*: (eg: 540-232-8765)
Email will be considered primary contact if phone number listed is outside of Local 540 Area Code 
E-mail*: (eg: jbob@vt.edu)


Division*

Division*:


League *

League*:
Click here for description of difference between "A" and "B" Leagues


University Affiliation*

University Affiliation*:
Click here for description of difference between Affiliations


Hokie Grail All-University Points*

Click here for description of Hokie Grail Participation Points Program
Use this registration to count towards Hokie Grail All-University Participation Points?* Yes   No
If Yes, what team/organization should points be awarded to?
If Yes, what Hokie Grail Division is this team/organization affiliated?

Schedule Conflicts
Check all times that you CANNOT play. At least 50% of the times available must be left open for play.

Monday: 2/4 5:30PM   6:30PM   7:30PM   8:30PM   9:30PM   10:30PM  
 
Tuesday: 2/5 5:30PM   6:30PM   7:30PM   8:30PM   9:30PM   10:30PM  
 
Wednesday: 2/6 5:30PM   6:30PM   7:30PM   8:30PM   9:30PM   10:30PM  
 
Thursday: 2/7 5:30PM   6:30PM   7:30PM   8:30PM   9:30PM   10:30PM  
 
Click here for complete Activity League/Tournament Schedule Play Dates


Other Intramural Activity Conflicts
List ALL other Intramural Sports/USOA Activities and/or Other Teams within this Activity that players are participating with.

Already scheduled game times for these activities should also be checked within the schedule conflicts listed above in order to avoid both activities/teams being scheduled to play at the same time.
Activity: Team Name:
Scheduled Game Times:
(eg: Wed @ 6:30pm, Playoffs, or TBA)
Division/League:
(eg: Men's A)

Activity: Team Name:
Scheduled Game Times:
(eg: Wed @ 6:30pm, Playoffs, or TBA)
Division/League:
(eg: Men's A)

Activity: Team Name:
Scheduled Game Times:
(eg: Wed @ 6:30pm, Playoffs, or TBA)
Division/League:
(eg: Men's A)

Activity: Team Name:
Scheduled Game Times:
(eg: Wed @ 6:30pm, Playoffs, or TBA)
Division/League:
(eg: Men's A)

Activity: Team Name:
Scheduled Game Times:
(eg: Wed @ 6:30pm, Playoffs, or TBA)
Division/League:
(eg: Men's A)



Program Participation Agreements *
Indicate your understanding and acceptance of the agreements listed below by placing a check beside each item.
Email imsports@vt.edu or Call 231-8297 with any questions

Each participant must be a current faculty/staff (20 hrs per week) or a currently enrolled student (1 credit hr and student fees) with a valid University Hokie Passport ID in order to be eligible to play. A participants may play for only one (1) single sex division and one (1) corec division (when league offered) within each sport. Any participant who has been ejected/suspended from intramural play for any reason must meet with an Intramural Sports Program Administrator to determine disciplinary action before being eligible to participate in any intramural activities. If it is discovered that a participant is an ineligible player then they will be removed from the league schedule.

Each participant must complete an Assumption of Risk Form by checking the box below stating that they agree to assume all risk associated through participation in this activity.

Each participant is responsible for any outside fees incurred through participation in this activity and will be responsible for supplying any equipment needed for play other than equipment that is supplied by the intramural sports program.

All participants are responsible for understanding the rules/regulations laid out for this activity, for understanding the policies/procedures implemented within the Department of Recreational Sports, for understanding that the registration information submitted as a request for participation in this activity may be shared with other participants as well as program administration/staff via posted activity information/schedules located on the intramural sports web site, as well as for granting VT Rec Sports the right to photograph/video their participation (voice, appearance, and name) during this event to be used for promotional purposes with no further compensation being paid.

Any discovery of false information will not be tolerated and will result in immediate suspension from intramural league/tournament play.



Assumption Of Risk*
Indicate your understanding and acceptance of the following statement by placing a check beside the box below.
 

I agree to indemnify, defend and hold harmless, Virginia Polytechnic Institute and State University (the University) and their officers, agents, and employees from any claims, damages, and actions of any kind or nature, whether at law or in equity, arising from my participation in this Intramural Program, provided that such liability is not attributable to the sole negligence of the University.

I realize that my participation in this activity involves risks of injury, including but not limited to tendonitis, strains, sprains, bruises, fractures, delayed muscle soreness, contusions, abrasions, serious eye damage and even the possibility of death. Also, I recognize that there are many other risks of injury including serious and disabling injuries which may arise due to my participation in this activity and that it is not possible to specifically list each and every individual injury risk. By agreeing to this statement I desire, consent, and voluntarily choose to take part in all such activities. Knowing the material risks and appreciating, knowing, and reasonably anticipating that other injuries and death is a possibility, I assume all the risks normally incident to the nature of the activities and agree that the University or any of its officers, agents, and employees conducting such activities will not be responsible for any damages or injuries resulting to me.

Furthermore, I also confirm that I have appropriate health care insurance for this activity or if not, that I will not rely upon the University for medical expenses. Also, I understand that any injury incurred and the resulting medical expense from that injury will be my responsibility and the University will not be responsible for any related expenses, other than those incurred at the University’s Student Health Services.

By checking this box you indicate your agreement with the release and health care verification above.


Intramural Sports Listserv*
Indicate your Selection
Both the Activity Listserv and the Intramural Sports Participant Listserv
I would like to be notified with information as it pertains to this activity as well as with information that will provide me with announcements about other upcoming intramural sports program activities

Activity Listserv Only
I would only like to be notified with information as it pertains to this activity only

No Listserv
I would not like to receive information concerning any intramural sports program activities




Virginia Tech Department of Recreational Sports
142 McComas Hall
Blacksburg, VA 24061-0358
540-231-6856

Return to Intramural Sports Web Page
Contact Intramural Sports Department