Drop-in Athlete Registration Form, Waiver, and Consent to Treat
You must be over 18 years of age or a parent/guardian of the participant to fill out this form.
Be sure to fill out all the required fields with the athletes information and be sure to use a valid email as it will serve as the main source of communication.
All participants MUST have an up-to-date USA Lacrosse Membership in order to participate.
In consideration of being allowed to participate in an Empire Lacrosse & Sports, Inc. (Empire Lacrosse) event, the undersigned acknowledges, appreciates, certifies and agrees that:
- I am over 18 years of age and/or a parent/guardian of the applicant.
- I understand that I (my child/ward) is participating in a contact sport and that injury, death, or other loss may occur.
- I will ensure that I (my child/ward) is properly equipped to play at all times.
- I will neither hold Empire Lacrosse & Sports Inc and/or their agents/employees (“Empire”) responsible nor liable in the event of an accident or injury to me (my child/ward.)
- In the event that I (my child/ward) requires medical treatment, the staff is authorized to act for me in accordance with their best judgment.
- My(my child/ward) participation includes possible exposure to and illness from infectious diseases, including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness, injury, and death does exist.
- If I(my child/ward) have a pre-existing health condition, exposure to COVID-19, or any other infectious disease may be more likely to cause serious illness, injury, or death.
- Empire Lacrosse cannot ensure that all other participants, including coaches and volunteers, are taking precautionary measures to mitigate risks to ensure the health and safety of other participants, coaches, and volunteers, and therefore, participation in a Empire Lacrosse Event involves risk of exposure to infectious disease.
- I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my(my child/ward) participation.
- I certify that I(my child/ward) have not recently tested positive for, and am not exhibiting symptoms of COVID-19, which include a cough, shortness of breath or difficulty breathing, loss of taste or smell, headache, chills, muscle or body aches and/or sore throat.
- I certify that I(my child/ward) do not have a household family member/roommate who has recently tested positive for or exhibited the above-referenced symptoms of COVID-19.
- I willingly agree to comply with all recommendations provided by Empire Lacrosse and USA Lacrosse to ensure safe play. If, however, I observe any unusual or significant hazard during my(my child/ward) presence or participation, I will remove myself(my child/ward) from participation and bring such to the attention of the nearest coach, staff member or volunteer, or official immediately.
- I, for myself(my child/ward) and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Empire Lacrosse, and their officers, officials, agents, and/or employees, Team Indiana, The Indiana Lacrosse Academy, USA Lacrosse Inc, other participants, volunteers, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
Assumption of Risk Statement
Attention all Athletes, Coaches, Spectators, and Event Employees; please be aware that lacrosse is a contact sport and that injury may occur during play or when watching a game. Players must have a signed liability waiver on file and should be fully equipped at all times in order to minimize their risk for injury. Coaches, Spectators, and Event Employees should be aware of their surroundings at all times. They should be sure to never walk behind the cage during play and they should never sit too close to the field during the game. Empire Lacrosse & Sports Inc and/or their agents/employees (“Empire”) are not responsible nor liable in the event of any accidents or injuries that may occur during Empire sponsored leagues, tournaments, events, or programs.
Photo/Video Image Use Consent and Release
Participation in or attendance at programs or events sponsored by Empire Lacrosse & Sports Inc and/or their agents/employees (“Empire”) constitutes the voluntary consent of the participant or attendee to: (a) be photographed, filmed, or videotaped by an Empire representative and (b) the reproduction and use of all such photographs, digital images, films, and likenesses for publicity purposes in publications, brochures, advertisements, promotional and marketing materials and all other media venues including the internet, all without further notice or compensation to participant or attendee who hereby releases to Empire all proprietary rights and copyrights in all such photographs, digital images, films and likenesses (including negatives, positives and prints) which shall be and remain the property of Empire.