Subscribe to our Newsletter

Green Lacrosse Boys Summer Camp 2024


The purpose of this document is to enable parents or guardians to authorize the provision of emergency treatment for children who become ill or injured while at any Green Lacrosse Club, Inc. event when parents cannot be reached.
Parent/Guardian Information

Grant of Consent:
I/we authorize the provision of emergency treatment for children who become ill or injured while at any Green Lacrosse Club, Inc. event when parents cannot be reached.

WAIVER INFORMATION
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above named doctor, or in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably available.

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

GREEN LACROSSE CLUB, INC.
AGREEMENT TO PARTICIPATE/RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in any Green Lacrosse Club, Inc. (GLC) team event and related events and activities, the undersigned acknowledges, appreciates and agrees that:

Participation in lacrosse involves certain inherent risks and, regardless of the care taken, it is impossible to ensure the participant's safety. Lacrosse requires considerable coordination, agility, and a high level of cardiovascular fitness. A variety of injuries may occur, including: minor scrapes, bruises, and sprains; more serious injuries, such as broken bones, cuts, concussions, eye injuries, and ligament strains/tears; catastrophic injuries such as heart attack, paralysis, and death.

These injuries may occur in lacrosse as a result of accidents such as slips, being struck by the ball in an unprotected area, being struck by a stick in an unauthorized fashion, colliding with another player, colliding with the goal, falling or excessive stress placed on the cardiovascular system. To help reduce the chance of injury to oneself or other participants, participants are expected to follow all official rules. All participants are expected to follow all rules. All participants are expected to: wear protective pads and gloves as required by the official rules.

I/We,hereby give permission for my/our child to participate in any GLC event. I/We understand there are obvious known dangers/risks inherent in participation in this program (or any program of this nature), including, but not limited to injuries, sustained through a fall or loss of personal property. I/we voluntarily agree to assume such risks. In consideration of GLC permitting my/our child's participation in any GLC's event, based on my/our representation that my/our child is in proper physical health and condition to participate, I/we agree:

1) To assume all risks of injury to my/our child and all risk of damage to or loss of my/our child's property arising from my/our child's participation in any GLC event.

2) To release and forever discharge GLC, their officers, agents, and employees from any and all claims or liability for injury, including death, and for property damage or loss which may be suffered by me or my child arising out of or in connection with my child's participation in any GLC event.

3) For my/our child, myself, our heirs, executors, administrators, and assigns to indemnify and hold harmless GLC, their officers, agents and employees from any and all liability, claims, demands, actions, loss and damage arising out of my/our child's participation in any GLC's event.

AGREEMENT: I agree to follow all preceding safety rules, all posted rules, and all rules common to the sport of lacrosse. Further, I agree to report any unsafe practices, conditions, or equipment to the management. I certify that: 1) I possess a sufficient degree of physical fitness to safely participate in lacrosse, 2) I understand that I am to discontinue activity at any time I feel undue discomfort or stress, and 3) I will indicate below any health related conditions that might affect my ability to play lacrosse and will immediately verbally inform the management if I feel any discomfort or stress. Player must indicate any medical conditions/illnesses he has including but not limited to Diabetes, Hearth Problems, Seizures, Asthma.

CONDITIONS: I have read this agreement to participate/release of liability agreement fully, and understand its terms. I know, understand, and appreciate the risks associated with playing lacrosse and I am voluntarily participating in the activity. I assume all the inherent risks of lacrosse, I understand in the event of medical emergency, an EMS will be called to render assistance and that I will be financially responsible for any expenses involved. I understand that I have given up substantial rights by signing it, and sign this freely and voluntarily without any inducement.


 

* indicates required fields