Player's Name *

First Name

Last Name

Player's Position *

Attack

Midfield

Defense

Goalie

Unknown (Beginner)

Player's Birthday *

MM

DD

YYYY

US Lacrosse Expiration Date *

MM

DD

YYYY

Player's Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian Name *

First Name

Last Name

Parent / Guardian Phone Number *

(###)

###

####

Parent / Guardian #2

First Name

Last Name

Parent / Guardian Email #2

First Name

Last Name

Parent / Guardian Phone Number #2

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Participant's Physician Name *

First Name

Last Name

Physician Phone Number *

(###)

###

####

Release of Liability Waiver & Statement of Assumption of Risk *

This release and statement is provided by AHSBL / Austin Youth Lacrosse and all coaches, staff members, agents, directors and officers of such organization. This waiver must be executed by a parent/legal guardian in order for the player to participate in said program. I, parent/guardian, give permission for our son/player to participate in the AHSBL / Austin Youth Lacrosse program, and have submitted required medical I, parent/guardian, understand that the dangers and risks of engaging in lacrosse can include serious injuries including but not limited to serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system and serious injury or impairment to other aspects of the body, health, and well-being. Because of the risks described above, I, parent/guardian, recognize the importance of listening to and following all of the coach’s instructions and warnings regarding playing techniques, training methods, rules of the sport and other team rules. I, parent/guardian, also recognize the importance of reading and adhering to all written instructions and written warnings regarding playing techniques, training methods, rules of the sport and other team rules, I, parent/guardian, understand that all instructions and warnings, verbal and written, are incorporated by reference into this agreement. As a parent/guardian, I therefore expressly agree to direct and to encourage our child/ward to obey all of the coach’s instructions and warning. In consideration of AHSBL / Austin Youth Lacrosse permitting the above player to practice or play in any other way participate in athletics, and to engage in all activities related to participation, including practicing, conditioning, playing, and traveling, I hereby acknowledge that the player named herein assumes all risks and hazards associated with such participation. As parent/guardian, I expressly consent to such participation by our child/ward/player. I agree to waive all claims of whatever nature, fully and finally, now and forever, for the child/ward/player, for ourselves, estates, heirs, administrators, executors, assignees, successors, and for all members of the family, and to release, exonerate, discharge and hold harmless AHSBL / Austin Youth Lacrosse, its coaches, staff, members, agents, directors and officers, volunteers, athletic trainers, physicians, and all those acting on behalf of AHSBL / Austin Youth Lacrosse from any and all liability, claims, causes of action or demands arising out of any injuries to the player or to his property, or losses of any kind of nature whatsoever, which may result from or occur in connection with his participation in AHSBL / Austin Youth Lacrosse athletics. I, parent/guardian, specifically acknowledge that certain sports are more high risk and may contain violent contact involving even greater risks of injury than other sports and I, parent/guardian,understand that our child/ward/player assumes those risks and I voluntarily consent to such participation by my child/ward/player. I do hereby request, authorize, and consent to accepting emergency care/treatment or first aid for my child/player as may be needed (including AED if available) by any available physician or licensed health care practitioner, and medical treatment facility/hospital, coach, parent, or “good Samaritan” and do hereby agree to indemnify and save harmless these individuals, and AHSBL / Austin Youth Lacrosse from any claim by any person whatsoever on account of such care and treatment for the player. If, in the judgement of the adult leader in charge, the registered player needs emergency medical treatment as a result of any injury or sickness while under the care or control of the AHSBL / Austin Youth Lacrosse, I do hereby request, authorize, and consent to such emergency treatment as amay need to be given to my child/player by any physician, licensed health care practitioner, or any medical treatment facility/hospital, specifically including the use of an AED; and I do hereby agree to indemnify and save harmless the adult leader in charge and the AHSBL / Austin Youth Lacrosse from any claim by any person whatsoever on account of such care and treatment of my child/player. If time permits, we prefer that the adult in charge use the physician listed in this registration which can be reached at the contact information listed in the registration to provide such care. I, parent/guardian of the participant listed above give consent and permit the taking of photos, video and audio during AHSBL / Austin Youth Lacrosse programs and events for the publication of AHSBL / Austin Youth Lacrosse, both online and in print.

I acknowledge that I have carefully read this agreement and fully understand the contents.

Parent / Guardian Signature *

By signing the digital signature below, I, parent/guardian, understands and agrees to the Release of Liability Waiver & Statement of Assumption of Risk listed above.

First Name

Last Name