ALTA GIRLS LACROSSE CLUB

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY

ALTA GIRLS LACROSSE HIGH SCHOOL TEAM / Date:20
Name: / Last / First
Address
City: / State: / Zip Code
Name of Parent or Guardian
Telephone Numbers / (Home) / (Cell)
Birth Date / Age / School Grade in Fall
INFORMED CONSENT/WAIVER OF LIABILITY – PLEASE READ BEFORE SIGNING

1.RELEASE AND INDEMNIFICATION: I hereby recognize and acknowledge that my/my child's participation in recreational activities may involve bodily and/or emotional injury to myself and/or my child. In consideration of my/my child's participation in such events, I, for myself, my child, my heirs, my executors and administrators, I hereby voluntarily and knowingly indemnify and hold harmless, defend, release, waive and discharge Alta Girls Lacrosse, and its officers and employees and volunteers from any and all suits, claims, liability, including negligence, based on any injury except those caused solely by the willful misconduct of Alta Girls Lacrosse, --including but not limited to carpooling to and from games and tournaments, tournament accommodations, practices, clinics, games, team activities/dinners etc. In addition, I agree that I or my insurance company will pay for medical, hospitalization or any other expenses resulting from my/my child's participation.

2.In consideration of Alta Girls Lacrosse permitting me or my ward to try out, practice, play or in any other way participate in athletics, and to engage in all activities related to my/my ward’s participation, including practicing, conditioning, playing and traveling, I AND MY WARD HEREBY VOLUNTARILY ASSUME ALL RISKS AND HAZARDS ASSOCIATED WITH SUCH PARTICIPATION, I AND MY WARD AGREE TO WAIVE ALL CLAIMS OF WHATEVER NATURE, fully and finally, now and forever, for myself, my ward, my heirs, my administrators, my executors, my assignees, my successors and for all members of my family and to release, exonerate, discharge and hold harmless Alta Girls Lacrosse, their trustees, officers, agents, servants, employees, their athletic staffs, all coaches, assistant coaches, physical education teachers, athletic trainers, physicians and others treating me or my ward from any and all liability claims causes and action or demands arising out of any injuries pertaining to Alta Girls Lacrosse.

3.REFUND POLICY: Alta Girls Lacrosse may withhold 25% of the refund (program registration fee) for administrative costs. All refunds must be requested in person, accompanied with a written refund request. No refund shall be given after the first day of the program.

4.EMERGENCY TREATMENT: I hereby authorize Alta Girls Lacrosse and staff to act on my behalf in accordance with their best judgment in case of an emergency involving me/my child, and agree to assume full responsibility for all expenses, medical or otherwise, that may arise there from.

5.EQUAL OPPORTUNITY: Alta Girls Lacrosse provides equal opportunity to participate regardless of race, creed, gender, and will, upon request, provide reasonable accommodations to individuals and disabilities.

I HAVE READ AND FULLY UNDERSTOOD THE ABOVE PROGRAM DETAILS, WAIVER AND RELEASE OF ALL CLAIMS AND PERMISSION TO SECURE TREATMENT.

Signature of ParticipantSignature (Parent or Legal Guardian