NES Player Waiver

PLAYER US LACROSSE MEMBERSHIP

US Lacrosse Number *

US Lacrosse Expiration *

Expiration Date must after the date of the tournament in order to participate.

PLAYER INFORMATION

Player's First Name *

Player's Last Name *

Street *

City *

State *

Zip Code *

Emergency Contact Name *

Emergency Contact Cell Phone *

Year of Graduation *

Club Team

Primary Position *

Jersey Number *

NES Waiver and Release

1. I/We, the legal guardian(s) of the named participant, approve of my child's attendance at the LPSWAG listed event and certify that she is in good health and able to participate in all program activities. 2. I/We acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result from not only their own actions, inactions or the negligence of others, the rules of play, or the conditions of the premises or of any equipment used. Further, that there may be risks not known to us or not reasonably foreseeable at this time. I/We agree to assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death 3. I/We agree to release, waive, discharge and covenant not to sue Lax Plus LLC, their affiliated clubs, their respective members, administrators, directors, coaches and other employees of said organizations, participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners or lessees of premises used to conduct the event, all of which are hereinafter referred to as "releases", from demand, losses, or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise. 4. I/We hereby agree to defend, indemnify and keep harmless, LaxPlus LLC, its agents, sponsors and employees against any and all liability, claims, judgments or demands for damages arising as a result of injuries sustained by the participant during or as a result of any course given the participant of the event. 5. I/We, being the legal guardians of the above participant, authorize the Lax Plus and its agents to request medical treatment as necessary to insure the well being of the participant. 6. In entering my name below, I/We acknowledge that by agreeing to the above, I/We are entering into the above waiver and release, understanding that I/We have given up substantial rights by agreeing to it, and agree to it voluntarily.

Parent/Guardian Name *

First

Last

Date / Time

Date

Time

Parent/Guardian Email