GREAT WESTERN PRESEASON LACROSSE TRAINING
Player Information & Release Form

Player________________________________________________________________________________

Address_______________________________________________________________________________

City__________________________________________________ State______ Zip Code_____________

Email____________________________________________ Telephone___________________________

Age_____   Date of Birth___________   Grade_____  School/Team_____________________________

Medical Coverage______________________________________________________________________

Policy Number__________________________________________________________________________

I understand that:
1) My child is in good physical condition and has no problems participating in the training;

2) I am hereby waiving and releasing the Great Western Lacrosse, its Director and its Staff from any and all liability for injuries incurred by my child while attending and participating in the training even if arising from negligence;

3) Great Western Lacrosse and its Director are not responsible for my child while coming to and leaving from and before or after the training;

4) I understand that if my child refuses to abide by all rules set forth by the Director, they will not allowed to continue participation;

In the event that I am unable to give parental consent, I hereby authorize the Physician/Hospital Staff at the nearest Hospital to provide care to include diagnostic procedures and medical treatment as necessary to my child, who is a minor. 
 (leave nothing blank)

Parental Signature________________________________________________ Date__________________

Print Parents Name______________________________________________________________________

Parents Home Phone_____________________________________________________________________

Work Phone_____________________________________________________________________________

Emergency Contact (Not Parent)___________________________________________________________

Emergency Contact Phone________________________________________________________________
_________________________________________________________________________________________________________
Office Use Only - Do Not Write In This Section
Amount Paid ____________  Date____________  Check #____________  Paid Online____________
Application_____   Combined Waiver____