Individual Player Information : 2009 Club National Championship


Player First Name:
Player Last Name:
Team Name :
Date of Birth mm/dd/yyyy
Age:
Parent/Guardian:
Address:
City:
 State: Zip:
US Lacrosse Member #
Uniform #:
Contact Phone(###-###-####):
Player Email:
Parent Email:


Amateur Minor Athletic Waiver and Release of Liability

In consideration of being allowed to participate in any way in the Champions of Tomorrow® athletics/sports program and related sports and activities the undersigned:

  • Agree that the parent(s) and/or legal guardians will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his/her coach or supervisor of such conditions and refuse to participate.
  • Acknowledges and fully understands that each participant will be engaging in activities that involve risk or serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence but the action, inaction or negligence of others, the rules of play, or the condition of the premises or any equipment used. Further, that they may be other risks not known to us or not reasonably foreseeable at this time.
  • Assume that all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.
  • Acknowledge and fully understand that each participant is not covered under this policy for expenses due to the individual's allergic reactions or asthma conditions.
  • Agree to have information submitted in this form published in Club National Championship programs and/or promotional materials..
  • Releases, waives, discharges and covenants not to sue the Champions of Tomorrow®, its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization; other participants, sponsoring agencies, sponsors, advertisers; and if applicable, owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as "releases", from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.

SIGN
 I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY