2011-2012 Highland Park Girls Lacrosse Registration Waivers

Players Name Waiver and Release of Liability Grade

I, being the parent or legal guardian, certify the Player has had a medical physical in the past year, was found fit for all physical endeavors required for playing the game of lacrosse, and is otherwise in good physical condition and can participate in the game of lacrosse. I understand that this game involves a significant amount of running, which will not pose a problem for the Player. I authorize the Player to participate in the Highland Park Girls Lacrosse athletic sports program, related events, activities, and tournaments (collectively, the Program) and, along with the Player, hereby AGREE: 1. The risk of injury from the activities involved in or associated with the Program is significant, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, INJURIES, DAMAGES OR LOSS, both known and unknown, that may be sustained by Player as a result of participation in the Program even if arising from the negligence of the Program, its Board, officers, sponsors, advertisers, coaches, players and parents and, if applicable, owners and lessors of premises used to conduct the event (collectively, RELEASEES) or others, and I assume full responsibility for participation and assumption of the risk; and, 3. I agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual, significant hazard during my presence or participation, I will remove myself from participation and bring such attention to the nearest official immediately; and, 4. For myself and on behalf of my heirs, assigns, personal representatives and Player, HEREBY FULLY RELEASE AND HOLD HARMLESS THE RELEASEES WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, EXPENSES, CLAIMS, LOSS, OR DAMAGES to the Player or property arising out of, as a result of, or in any way associated with the Players participation in the Program, whether arising from the negligence of the Releasees or otherwise. 5. I agree that photographs and/or video tapes in any form or medium of Player may be taken or used by the Program for any reason, including, but not limited to, public relations, advertising, sales, etc. I HAVE FULLY READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

PARENT/GUARDIAN SIGNATURE

PLAYER SIGNATURE

Printed Name

Printed Name

Date

Date

Medical Treatment Authorization

I hereby give my consent to Highland Park Girls Lacrosse to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my childs participation in Highland Park Girls Lacrosse sponsored or sanctioned events and I agree to cover all costs incurred on my childs behalf.

Name of Player Fathers/Guardians Name Mothers/Guardians Name Emergency Contacts: 1. Home # 2. Home # Doctors Name: Dentists Name: Hospital Preference: Health Insurance Company: Group/Plan # Phone # Phone #

Date

Cell # Cell #

ID or Contract #:

For any participant who is not yet 18 years old: As legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child to participate in any Highland Park Girls Lacrosse recognized or sanctioned events, and I accept each of the above conditions.

Parent/Guardian Signature

Date

Printed name