Canfield Lacrosse Club | Canfield Ohio - (Canfield, OH)

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SUMMER SKILLS LACROSSE CLINIC JULY 22-26 6:30 to 8:30PM

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

* Birthdate:

Email:

Gender:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Preferred Phone:

Work Phone:

Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Canfield Lacrosse Club
HOLD HARMLESS AGREEMENT AND
RELEASE OF LIABILITY FORM FOR MINORS

I, _______________________, the undersigned, am the parent, legal guardian with the authority to execute this Agreement and Release on behalf of __________________________.

The Parent/Legal Guardian makes the following declarations on behalf of the minor:

I am registered to participate in the following activity: Canfield Lacrosse Club Skills Clinic, (“activity”), offered by the Canfield Lacrosse Club (“Club”). The activity will take place during the following dates, July 22nd through July 26th (dates), at Hilltop elementary School, Canfield, Ohio (location).
I understand and recognize that I am responsible for my own well-being and the well-being of the other participants. I declare that I recognize that it is in my best interest, as well as that of the other participants, to follow the suggestions, guidelines, and/or rules of the activity(ies) supervisors, and/or coordinators and that my participation in this activity is entirely voluntary or is at the direction or request of persons or entities not associated with Canfield Lacrosse Club. I fully understand and appreciate the potential dangers, hazards and/or risks, directly and/or indirectly inherent in participating in this activity, which could also include the loss of life, serious loss of limb, or loss of property. Also, I understand that the consumption of alcohol and/or use of drugs is strictly prohibited and could result in my dismissal from further participation in the activity. I understand that any Club personnel or agents also participating in this activity are not necessarily medically trained to care for any physical or medical problems that may occur during this activity. I further understand that the Club does not carry medical or liability insurance for me while I am participating in this activity. By placing my signature below, I acknowledge to the Club that I have adequate medical and hospitalization insurance for any injuries that I may incur as a result of participating in this activity. NOW, THEREFORE, in consideration for being allowed to participate in this activity, I agree to hold the supervisor(s) and coordinator(s) of this activity, Canfield Lacrosse Club, agents, officers, and volunteers harmless for any and all direct, indirect, special or consequential damages, or costs, legal and otherwise, which I may incur as a result of my participation in this activity(ies), even if due to the negligence of Canfield Lacrosse Club or any person serving in the above-identified capacities. I have read the above terms of this Agreement/Release, and I understand and voluntarily agree to the terms and conditions. This Agreement/Release shall be binding upon the heirs, administrators, executors, and assigns of the undersigned.

As a parent/guardian authorized on behalf of the above-named minor, I have read the above terms of this Agreement, and I understand and agree to the terms and conditions stated herein. This Agreement/Release shall be binding upon the heirs, administrators, executors, and assigns of the undersigned. I further agree to indemnify Canfield Lacrosse Club, its agents, officers and volunteers against any action brought against Canfield Lacrosse Club by the above-named Participant, including but not limited to an action brought by him or her upon reaching the age of majority. I warrant that I am authorized to execute this Agreement and Release on behalf of the above-named minor.

Parent/Guardian Signature: ______________________________________________

Parent/Guardian Address: __________________________________________________________________
Address, City, State, Zip

Parent/Guardian Contact Information:
Home:____________________
Cell:___________

*** Insert your waiver information here ***

I/we agree with the above *

Signature:

Date:

* indicates required fields

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Canfield Lacrosse Club | Canfield Ohio

SUMMER SKILLS LACROSSE CLINIC JULY 22-26 6:30 to 8:30PM