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Registration Form

Name:

Phone:

Child's Name

Age

School

IN CONSIDERATION of being permitted to play, practice, compete, observe, or participate in any way in the La Crosse Area Lacrosse Association, here on known as LALA, EACH OF THE UNDERSIGNED, participate for himself, or as parent(s) or legal guardian(s) of any minor, as well as for his personal representatives, heirs, and next of kin hereby: 1. ACKNOWLEDGES AND AGREES that participant has had a recent physical, and I (we) represent that he is mentally and physically fit to play lacrosse. 2. ACKNOWLEDGES AND ASSUMES responsibility for participant’s transportation to and from practice and games. 3. ACKNOWLEDGES AND AGREES that lacrosse is a potentially dangerous sport and may involve the risk of serious injury and /or death and /or property damage, and that then risk shall be fully assumed by participant. 4. RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE LALA, their teams, their employees, personnel, servants, agents, organizers, officers, coaches, staff, sponsors, advertisers, owners, and lessees of premises used to conduct events, and each of them and their insurers, all for the purposes herein referred to as “Releasers,” FROM ALL LIABILITY, TO THE UNDERSIGNED, for himself, or as parent or legal guardian of any minor, as well as for his personal representatives, heirs and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFORE ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR DEATH ARISING OUT OF OR RELATED TO LALA’S PROGRAM ACTIVITIES AND EVENTS WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASES OR OTHERWISE. 5. AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasers and each of them and their insurers FROM ANY LOSS, LIABILITY, DAMAGE, OR COST they may incur arising out of or related to the LALA PROGRAM ACTIVITIES, AND EVENTS WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASERS OR OTHERWISE. 6. ASSUMES FULL RESPONSIBILTY FOR THE RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE arising out of or related to the LALA PROGRAM ACTIVITIES AND EVENT WHETHER CAUSED BY THE NEGLIGENCE OF RELEASERS OR OTHERWISE. 7. AGREES that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by Releasers, and is intended to be as broad and inclusive as permitted by the laws of the State of Wisconsin, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 8. AGREES that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement may not be orally modified, and may not be modified in writing without first obtaining the written consent of each of the Releasers. I (WE) HAVE READ THIS RELEASE AND WAIVER OF LIABILLRY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTANING THE TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNDCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. NOTE: BOTH PARENTS MUST SIGN FOR MINORS

By Checking this box, I agree to the above.

Participants Name

Legal Guardian #1 E-Signature

Date