Lacrosse Under 21

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Baltimore Summer Camp I - Starts June 10th

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

ATHLETE WAIVER & RELEASE OF LIABILITY INFORMATION

Please read carefully and be aware that by registering for and having your minor child/ward participate in the organized sport of lacrosse, you will be waiving all claims for injuries your child/ward might sustain arising out of her/his participation.

I recognize and acknowledge that there are certain risks of physical injury to participants in the organized team sport of lacrosse and I knowingly assume full responsibility for my minor child/ward's particiaption and thus the full risk of any and all injuries, damages or loss, regardless of severity, including permanent disability, paralysis and death, that my minor child/ward may sustain as a result of said participation. I do hereby forever waive, release, discharge and relinquish all claims against Lacrosse Under 21, LLC, its affiliated lacrosse events and venues, its Owner(s), officers, agents, employees,and volunteers, insurers, successors, and assigns from any and all claims, costs, expenses, attorney fees, liabilities, losses, damages for personal injury, disability, death, property loss or otherwise that I or my minor child/ward may have or which may accrue as a result of, arising out of, connected with, or in any way associated with her/his participation in the organized team sport of lacrosse and/or any related activities, program, events, or services.

I also grant permission to Lacrosse Under 21, LLC to use any and all images of any family members taken during the event or during any of their programs on the website or in any promotional material as they see fit. I understand that the email address I provided to Lacrosse Under 21, LLC will be used to send informational promotional materials as they see fit.

I certify that my minor child/ward is in good physical condition and can participate in the sport of lacrosse. Further, I authorize the club or event administrators to request medical treatment for my minor child/ward as necessary to insure their well-being.

I have read and fully understand the above Athlete Waiver & Release of Liability and agree to its terms in its entirety

I/we agree with the above *

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Baltimore Summer Camp I - Starts June 10th