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In consideration of my and/or my child’s membership in US Lacrosse, and my and/or my child’s participation in the Harborfields Lacrosse Club program and other US Lacrosse sanctioned, recognized or sponsored events (“Covered Events”), I agree to the following:

1. WAIVER & RELEASE: As parent or lawfull guardian of my minor child I am fully aware of and appreciate the risks, including the risks of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event. I agree on behalf of my child, myself, my heirs and personal representatives, that US Lacrosse, the Harborfields Lacrosse Club, the host organization and the sponsor or sponsors with respect to a Covered Event, together with coaches, officials, volunteers, employees, agents, officers and directors of the the Harborfields Lacrosse Club, the host organization and any such sponsors shall not be held liable for any injury, loss of life or other loss or damage as a result of my participation in a Covered Event. This Waiver & Release shall also be for the benefit of and run in favor of any youth organization that requires participants to become members of US Lacrosse as a condition to their participation in such organization’s youth lacrosse events, which shall constitute Covered Events for purposes of this Waiver & Release, and any such youth lacrosse league shall constitute the host organization for such Covered Events.

2. MEDICAL ATTENTION: I hereby give my consent to US Lacrosse and the Harborfields Lacrosse Club, the host organization of any Covered Event to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency services as warranted in the course of my participation in Covered Events.

3. READINESS TO COMPETE: I will only participate in those Covered Events in which I believe I am physically and psychologically prepared to compete.

4. INFORMATION CERTIFICATION: I certify that all of the information provided by my parent or lawful guardian in this Application, including without limitation my membership category, is true, accurate and complete and I understand that any untrue, inaccurate or incomplete statement or information will automatically invalidate my membership and all of the benefits of membership in US Lacrosse.

5. CODE OF CONDUCT: I agree to all terms on the reverse side of this form (refers to accepted US Lacrosse/Positive Coaching Alliance Code of Conduct).



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