Instructions:
1.) Each Player should read the statement below before completing and signing this Waiver & Release Form.
2.) Parents 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 the Great Western Indoor Lacrosse League. I acknowledge, agree to & understand that:
1.) Readiness To Compete: Voluntary and of my own free will, I elect to participate as a member of a Great Western Indoor Lacrosse League. 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.
2.) Readiness To Compete: I hereby give my consent to US Lacrosse and to Great Western Lacrosse, The Poway Sportsplex 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.) Waiver & Release of Liability: I am fully aware of and appreciate the risks associated with participation in a lacrosse event, including the risk of catastrophic injury, paralysis and even death, as well as other types of damages and loss. I further agree on behalf of myself, my heirs, and personal representatives, that US Lacrosse, Great Western Lacrosse, the Poway Sportsplex, the host organization, and sponsors of any US Lacrosse event, along with their 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(s). 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.
Print Players Name_____________________________ Players Signature_____________________________
US Lacrosse Membership Number______________________________ Exp. Date_______________
Street Address____________________________________City_____________________State____ Zip______
Date___________ Email: ____________________________________________
Print Parents Name_____________________________Parents Signature X___________________________
Great Western Indoor Lacrosse League
AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY FORM
In consideration of being allowed to participate in any way in a Great Western Lacrosse athletic sports programs, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury from activities involved in this program is significant, including the potential for permanent injury and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and, assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Great Western Lacrosse Company, its Director, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event {“RELEASEES”}, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily.
This is to certify that I, as parent / guardian with legal responsibility for this participant, do consent and agree to his release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from negligence. ( leave nothing blank or this form will be returned for completion)
X_________________________________________________________
Date Signed___________
( Parent’s / Guardian’s Signature )
Home Phone_____________________________ Cell
Phone_______________________________