Parent/Guardian *

First Name

Last Name

Player Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Clinic Registration *

Boys

Girls

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY READ BEFORE ELECTRONICALLY SIGNING AND SUBMITTING, In consideration of being allowed to participate in any way in [Palmetto Beach Lacrosse League, LLC - Palmetto Beach Lacrosse Academy] athletic sports program, related events and activities, including but not limited to practices, games, clinics, and tournaments, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, The risk of physical injury is an inherent danger in contact sports such as lacrosse; I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS FOR MY CHILD, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and, I willingly agree that my child will comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or my child’s participation, I will remove my child from participation and bring such to the attention of the nearest official immediately; and, I, for myself and on behalf of my child, heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Palmetto Beach Lacrosse League, LLC - Palmetto Beach Lacrosse Academy) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of the activity and his/her responsibilities for adhering to the rules and regulations. 1 of 2 Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s/ward’s involvement or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. By selecting yes I have acknowledged reading and understanding the aforementioned Waiver form, which will be bound upon registering the players. I am furthermore acknowledging that I am the parent/guardian of the registered player and I have legal authority to enter into this waiver agreement. *

Parent/Guardian Release and Waiver Form

Yes, I have read and agree to the parental Waiver

No, I decline the parental waiver form

I am the parent or legal guardian of the player being registered and hereby grant Palmetto Beach Lacrosse League, LLC a.k.a. “Palmetto Beach Lacrosse Academy”, and its agents, my permission to use photographs and/or video clips of lacrosse practices, games, tournaments, scrimmages, and team events, for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *

Picture/Video/Social Media Rights Release Form

Yes, I have read and agree to release any rights to use video and photography

No, I decline to allow the use of photos of video of my child