YOUTH CLINIC REGISTRATION

Participant Contact Information

Current USL #:

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

School:

Grade:

Age:

Parent/Guardian  Information

Parent/Guardian Name:

Cell or Emergency Phone #:

Email:

BOBBY CAMPBELL LACROSSE CLINIC WAIVER AND RELEASE OF LIABILITY:

Participant Signature:

Release and covenant not to sue The Bobby Campbell Lacrosse Foundation (sponsors of the clinic), its respective administrators, directors, officers, agents, coaches, and other volunteers or employees of the organizations, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasors of premises used to conduct the event, all of which are hereby referred to as “releasees”, from any and all liability to each of the undersigned, his or her next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused, in whole or in part by the negligence of the releasees.

Acknowledge and fully understand that each participant will be engaging in activities that involve the risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions or negligence but from the action, inaction or negligence of others, the rules of play, or the conditions of the premises or of any of the equipment used. Further, that there may be other risks not known to us or reasonably foreseeable at this time.

. Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such conditions and refuse to participate.

Assume all of the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death.

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In consideration of being allowed to participate in any way in the Bobby Campbell Lacrosse Foundation Clinic (the Clinic) events and activities, the undersigned:

Understand that the releasees take no responsibility for verifying my physical readiness or condition to participate in this lacrosse program. 

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Authorize that any photographs or video images taken of my son/daughter at the clinic may be used at no cost to the Bobby Campbell Lacrosse Foundation for the purposes of marketing, fundraising or to otherwise promote the Bobby Campbell Lacrosse Foundation and its programs.

I / WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I / WE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING BELOW AND DO SO VOLUNTARILY.