Waiver: I do hereby agree to release the cities of Roseville, Little Canada, Stillwater and Blaine as well as the counties of Anoka, Ramsey and Washington and the Roseville Senior Softball Association, its Officers, Directors, Managers and Players from any liability, claim, injury, or damage of whatever kind or nature resulting from my participation in the game of softball. I further understand that there is always a risk in group activities of contracting viruses or other illnesses and my release is inclusive of such. I give my permission for the rendering of any necessary emergency medical treatment whatsoever which may have to be rendered due to my participation in this activity.
| Name / Age / Address | Phone / Email | Paid / High School | Signature | |
|---|---|---|---|---|
| Arnold, Steve | 70 | 612-202-0948 (C) | ||
| 10714 Buchanan St Blaine, MN 55434 | wmsarnold@msn.com | NW - Delohi MD | ||
| Emergency contact | Name: | Phone: | ||
| . | ||||
| Brown'Pena, Luis | 72 | 651-442-0956 (C) | ||
| 965 Smith Ave S West St. Paul, MN 55118 | lbrownpena@yahoo.com | Nicaragua | ||
| Emergency contact | Name: Maria Victoria Brown'Pena | Phone: 612-414-1585 | ||
| . | ||||
| Dockery, Ron | 73 | 651-773-8246 (H) | ||
| 284 Wildridge Road Mahtomedi, MN 55115 | rdockery512@gmail.com | Ford HS, Laurens, SC | ||
| Emergency contact | Name: Susan Dockery | Phone: 651 206-9482 | ||
| . | ||||
| Forys, Lance | 72 | 651-271-2348 (H) | ||
| 1365 Whistler Pt Rd Woodbury, MN 55129 | l.forys@hotmail.com | Johnson | ||
| Emergency contact | Name: Jan | Phone: 651-739-9508 | ||
| . | ||||
| Funkenbusch, Arnie | 72 | 612-297-8469 (C) | ||
| 1040 Hallam Ave N Mahtomedi, MN 55115 | afunkenbusch@msn.com | Houghton | ||
| Emergency contact | Name: Diane Furlong | Phone: 651-260-3942 | ||
| . | ||||
| Goin, Mark | 71 | 651-278-1881 (H) 651-428-8623 (C) | ||
| 19109 Cottage Rd Farmington, MN 55024 | mwagoin@comcast.net | Kennedy | ||
| Emergency contact | Name: Liz | Phone: 651-428-8623 | ||
| . | ||||
| Hall, Vernon | 75 | 651-210-2179 (H) | ||
| 1976 Rishworth Lane White Bear Lake, MN 55110 | vernjhall@gmail.com | Mounds View | ||
| Emergency contact | Name: | Phone: | ||
| . | ||||
| Hurry, David | 72 | 651 442-6611 (C) | ||
| 14565 109th St Ct N Stillwater, MN 55082 | dlhurry@msn.com | |||
| Emergency contact | Name: Denise Hurry | Phone: 612 202-5757 | ||
| . | ||||
| Kukielka, Mick | 75 | 612-374-2629 (H) | ||
| 2105 Fremont Ave S Minneapolis, MN 55405 | mickkukielka1@gmail.com | Mpls Edison | ||
| Emergency contact | Name: Kathy Kukielka | Phone: 612-916-5087 | ||
| . | ||||
| Ritter, Dick | 85 | 540 359-2315 (H) | ||
| 10521 Golden Eagle Tr Woodbury, MN 55129 | dick_ritter@yahoo.com | Prairie Farm, WI | ||
| Emergency contact | Name: | Phone: | ||
| . | ||||
| Severson, Dale | 87 | 651-483-0766 (H) | ||
| 20 E Gilfillan Rd St Paul, MN 55127 | sfseverson@gmail.com | Eau Claire, WI | ||
| Emergency contact | Name: Sharon | Phone: 651-895-6565 | ||
| . | ||||
| Sundmark, Dave | 72 | 651-735-0386 (H) 651-261-4440 (C) | ||
| 2206 Marillac Ln St Paul, MN 55119 | djsundmark@comcast.net | Harding | ||
| Emergency contact | Name: Lynn Sundmark | Phone: 651-735-0386 | ||
| . | ||||
| Swanson, Glenn | 79 | 651-430-2267 (H) | ||
| 10258 119th St N Stillwater, MN 55082 | Harding | |||
| Emergency contact | Name: | Phone: | ||
| . | ||||
| Zicopula, Jim | 73 | 651-483-9809 (H) | ||
| 166 Woodridge Ln Lino Lakes, MN 55014 | zposter@aol.com | Elmhurst, NY | ||
| Emergency contact | Name: Chris | Phone: 612-597-4705 | ||
| . | ||||