Waiver and Release Form
Waiver and Release Form
Medical Attention
- 1.I am fully aware of and appreciate the risks, including the risks of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosseI agree on behalf of myself, my heirs and personal representatives, that Leopard Lacrosse, the host organization and the sponsor or sponsors with respect to a Covered Event, together with coaches, officials, volunteers, employees, agents, officers and directors of the host organization and any such sponsors shall not be held liable for any injury, loss of life or other loss or damage as a result of my participation in a Covered Event. This Waiver and Release shall also be for the benefit of and run in favor of any youth organization that requires participants to become members of Leopard Lacrosse as a condition to their participation in such organization’s youth lacrosse events, which shall constitute Covered Events for purposes of this Waiver and Release, and any such youth lacrosse club shall constitute the host organization for such Covered Events.
- 2.I hereby give my consent to Leopard Lacrosse and the host organization of any Covered Event to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency services as warranted in the course of my participation in Covered Events.
Participant Primary Medical Insurance Carrier is:
Policy Number:
Every Member must sign below:
If participant is under 18, then a parent or legal guardian of this participant must sign.
As member, or as parent or legal guardian of a member under 18, I hereby verify by my signature below that I fully understand and accept the above conditions.
Printed Name of Player:
Printed Name of signor:
Signature: Date: