PLAYER US LACROSSE MEMBERSHIP US Lacrosse Number * 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 * 2025 2026 2027 2028 2029 2030 Team Name * 3d NE South Girls 2025/26 3d New England 2025 3d New England 2026 3d New England 2027 Albany Power 25/26 Bullets 2025 Silver Central Lacrosse 2025 Central Lacrosse 26/27 Flare Lacrosse Flare Lacrosse 26/2027 Gold Star Marines Gold Star Navy GSE 2025 GSE 2028 GSE 26/2027 GSE 29/30 Houlagans 25/26 Houlagans 28 Yellow Houlagans 28 Green Lax Plus 2025/26 Black Lax Plus 2025/26 White Lax Plus 2027/28 Lax Plus 2029/30 LXC 2025 Green LXC 2025 White LXC 2025/26 Black LXC 2026 Green LXC 2027 Green LXC 2027/28 Black LXC 2028 Green LXC 2028/29 Emerald LXC 2029/30 Shamrock LXC Central 2025 LXC Central 2026/27 MXB 2025 NH Tomahawks 2025 Purple NH Tomahawks 2026 Purple NH Tomahawks 2027 Purple REV 2025 REV 2026 REV 2027/28 Snipers 2027/28 Snipers 2029/30 Storm 2025/26 Black Storm 2025/26 Purple Storm 2027/28 Storm 2029/30 Primary Position * Goalie Defense Midfield Attack Jersey Number * LPSWAG EVENT 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.
Communicable Disease/Covid Waiver
WAIVER/RELEASE/ASSUMPTION OF RISK FOR COMMUNICABLE DISEASES INCLUDING COVID-19:
In consideration of being allowed to participate in programs, related events, or activities offered by Lax Plus LLC, including the right to enter Lax Plus’s premises, or access its fields, the undersigned acknowledges, appreciates, understands, and agrees that:
1. Participation includes possible exposure to, and illness from, infectious diseases including but not limited to MRSA, influenza, and COVID-19 (collectively “Infectious Diseases”). While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist;
2. Lax Plus cannot prevent you or your child(ren) from becoming exposed to, contracting, or spreading Infectious Diseases while participating in Lax Plus’s programs or accessing its premises or fields. It is not possible to prevent against the presence of Infectious Diseases. Therefore, if you choose to utilize services or enter into Lax Plus’s premises or fields, you may be exposing yourself to Infectious Diseases and or increasing your risk of contracting or spreading Infectious Diseases;
3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against Infectious Diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation, and bring such to the attention of the nearest Lax Plus official immediately;
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, HOLD HARMLESS, AND AGREE TO INDEMNIFY LAX PLUS, LLC, their officers, directors, officials, agents, employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the programs (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law;
5. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS PERTAINING TO INFECTIOUS DISEASES, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and
6. I certify if at any time following the execution of this release, myself or my child(ren) (1) experience any symptoms of COVID-19, (2) have come in contact with any individual who tested positive for COVID-19, (3) have tested positive for COVID-19, or (4) have traveled outside the United States within the last 14 days, that I and or my child(ren) will abstain from participating in all Lax Plus activities and will not under any circumstance travel to the premises for at least Fourteen (14) days. Furthermore, I certify that if myself or my child(ren) have been diagnosed with COVID-19 that I will not return to the premises until after at least Fourteen (14) days have elapsed from diagnosis and myself or my child(ren) have tested negative for COVID-19.
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
I HAVE READ THIS WAIVER/RELEASE/ASSUMPTION OF RISK FOR COMMUNICABLE DISEASES INCLUDING COVID-19, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. *
Parent/Guardian Email *