LONG ISLAND SOUND
LACROSSE (Waiver) Participant Waiver &
Release
(Must
be included with application)
Signature
is required to participate
Applicant’s
Name ______________________________
Address:
Street_________________________
City
_______________________Zip__________
In
Consideration of my participation in Long Island Sound Lacrosse, sponsored
events and activities, I agree to the following: 1. Waiver and Release: I am fully aware of
and appreciate the risk, including the risk of catastrophic injury, paralysis
and even death, as well as other damages and losses, associated with
participation in a lacrosse event and related sports conditioning activities. I
further agree on behalf of myself, my heirs, and personal representatives,
that Long Island Sound Lacrosse along with coaches, officials,
referees, volunteers, employees, agents, sponsors, officers and directors of
these organizations, shall not be liable for any injury, loss or damage
occurring as a result of my participation in the event.
2.
Medical Attention: I
herby give my consent to Long Island Sound Lacrosse to provide,
through a medical staff of its choice, customary medical/athletic training
attention, transportation and emergency medical services.
3.
Readiness to Compete: I will only participate in those competitions or
activities in which I believe I am physically and psychologically prepared to
participate.
_______________________________________________________Signature
of Participant (Required!!)
Participant
Under Age 18 As legal guardian of this participant, I
herby verify by my signature below that I have read and fully understand each
of the conditions under the Participant Wavier & Release section above for
permitting my child to participate in any Long Island Sound Lacrosse
sponsored events and activities, and I accept each of the conditions,
especially the waiver and release set forth in paragraph One.
_______________________________________________________Signature
of Parent/Guardian (Required for Participant Under Age 18!!)
Medical
Treatment Authorization: I/We, being the legal guardians of the above applicant
authorize Long Island Sound Lacrosse and its agent’s permission to request
medical treatment as necessary to insure the well being of our dependent.
_____________________________________________Signature
of Parent/Guardian (Required for Participant Under Age 18!!)
_____________________________________________Signature
of Parent/Guardian (Required for Participant Under Age 18!!)
Date:
__________________________
Athlete's E-mail___________________________________
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