Girls' Lacrosse Player's Clinic at THE OVERLAKE SCHOOL, February 23, 2002

Player Name:   

Grade:                     School/Club:

Home Phone:             

Email:     Number of years played: 

Liability/Injury Waiver and Release  

Required for child to participate in event. Parents please review and sign below.

Player Name: 

Does your child currently have medical insurance:  Yes/No

Emergency Contact:            

Emergency Day Phone:

Participation in athletic activities involves the potential of minor to serious injuries to participants.  Please carefully consider the potential danger and risks associated with athletic participation before you or your child decides to participate in the NWSLA Girls' Lacrosse Players Clinic.  I hereby acknowledge that participation in lacrosse including practices and drills and related activities may result in injury to the participant.  I understand that neither the organizers, coaches, counselors, individuals or anyone connected to the NWSLA Girls' Lacrosse Players Clinic will assume any medical, dental or other expenses incurred as a result of any injury, and I release any organizers, coaches, counselors, individuals or anyone connected to the NWSLA Girls' Lacrosse Players Clinic, from any and all claims and liabilities of any nature arising from the participation of the NWSLA Girls' Lacrosse Players Clinic.  I hereby authorize the counselors to act on my behalf according to their best judgment in emergencies requiring medical attention.

Parental signature is required for child to participate.

Parent Signature:                                                                        Date: