___ Men's ___ Women's ___ Mixed Levels of Play: ____ Elite ____ Competitive ____ Recreationa
(Only for Volleyball and Basketball)
Note: Sexually explicit and/or offensive names prohibited. Intramural Sports reserves the right to change and/or alter Team Names if necessary.
Team Captain (Personal):
Name: Phone : __________________________
Address: Postal :
Alternate Contact:_____________________________________ Alternate Contact Phone:
Alternate Contact Email: ________________________________________________
TEAM ROSTER - All information is required. Individuals will not be permitted to play without a valid Student I.D #
Faculty Year of
Student I.D. # Enrolled Study PHONE#
Assumption of Risk: Participation in the University of Regina Intramural Sports Program involves the risk of personal injury. The use of
equipment, facilities and premises of the University of Regina and/or cooperating agencies by persons participating in Intramural Sports
activities shall consitute acceptance of that risk regardless of the nature of the injury. Photo Policy: Participation in the Program grants
the University of Regina permission to reproduce any photos for publciity purposes.
FOR OFFICE USE ONLY