Instructions:           
1.) Each Player should read the statement below before completing and signing this Waiver & Release Form.
2.) Parents / Guardians should read the statement below before completing and signing this Waiver & Release Form.
Agreement:  In consideration of my membership in US Lacrosse and of my participation in the sponsored activities of a Great Western Lacrosse Program, I acknowledge, agree to and understand that:

1.)     Waiver & Release of Liability:  I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other types of damages and losses, associated with participation in a lacrosse event. I further agree on behalf of myself, my heirs, and personal representatives, that US Lacrosse, Great Western Lacrosse, San Diego State University, the host organization, and sponsors of any US Lacrosse sanctioned event, along with the coaches, volunteers, employees, agents, officers and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event, or as a result of equipment that may have been provided to me for these activities.  

2.)     Medical Attention:     I hereby give my consent to US Lacrosse and to Great Western Lacrosse, San Diego State University and the host organization of any US Lacrosse sponsored event to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted through the course of my participation in sponsored lacrosse activities.

3.)     Readiness To Compete:    Voluntary and of my own free will, I elect to participate as a member of a Great Western Lacrosse Program. I will only participate in those US Lacrosse competitions and activities sponsored by Great Western Lacrosse for which I believe I am physically and psychologically prepared to compete.

4.)     Code of Conduct:   I have read and agree to all terms in the US Lacrosse Code of Conduct, especially with regard to my responsibilities as a player. My signature below is my acknowledgement that I have read and understood every provision of this Waiver and Release of Liability, and that I agree to abide by it.
(  L e a v e   N o t h i n g   B l a n k  )

Print Players Name____________________________________  Date_________________

Players Signature___________________________________________________________

US Lacrosse Number_________________________________ Exp. Date______________

Street Address_____________________________________________________________

City____________________________________ State_______  Zip Code______________

Print Parents Name__________________________________________________________

Parents Signature___________________________________________________________

Date_____________    Email: __________________________________________________