Adult Waiver/Release/Liberty Girls Lacrosse Club
Amateur Athletic Waiver and Release of Liability
Read before Signing
In consideration of being allowed to participate in any way in Liberty Girls Lacrosse Club athletic
sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees
that:
1) The risk of injuries from the activities involved in this program is significant, including the
potential for permanent paralysis and death, and while particular rules, equipment, and personal
discipline may reduce this risk, the risk of serious injury does exist; and,
2) 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 participation; and,
3) I willingly agree to comply with the stated and customary terms and conditions for participation.
If, however, I observe any unusual significant hazard during my presence or participation, I will
remove myself from participation and bring such to the attention of the nearest official immediately;
and.
4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin,
HEREBY RELEASE AND HOLD HARMLESS Liberty Girls Lacrosse Club, 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, DISABLITY, DEATH, or loss or damage to person or property,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I HAVE READ THE 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.
_______________________________
(Participant’s signature)
______________________________
(Printed participant’s name)
DATE SIGNED: ____/____/_______
For Participants of Minority Age
(Under age 18 at time of registration)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do
consent and agree to his/her release as provided above of all the Releasees, and for
myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold
harmless the Releasees from any and all liabilities incident to my minor child’s
involvement or participation in these programs as provided above, EVEN IF ARISING
FROM THEIR NEGLIGENCE.
____________________________ DATE SIGNED: ____/____/_____
(Parent/Guardian Signature)
Emergency Phone Number: _________________________
Amateur Athletic Waiver and Release of Liability
Read before Signing
In consideration of being allowed to participate in any way in Liberty Girls Lacrosse Club athletic
sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees
that:
1) The risk of injuries from the activities involved in this program is significant, including the
potential for permanent paralysis and death, and while particular rules, equipment, and personal
discipline may reduce this risk, the risk of serious injury does exist; and,
2) 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 participation; and,
3) I willingly agree to comply with the stated and customary terms and conditions for participation.
If, however, I observe any unusual significant hazard during my presence or participation, I will
remove myself from participation and bring such to the attention of the nearest official immediately;
and.
4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin,
HEREBY RELEASE AND HOLD HARMLESS Liberty Girls Lacrosse Club, 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, DISABLITY, DEATH, or loss or damage to person or property,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I HAVE READ THE 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.
_______________________________
(Participant’s signature)
______________________________
(Printed participant’s name)
DATE SIGNED: ____/____/_______
For Participants of Minority Age
(Under age 18 at time of registration)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do
consent and agree to his/her release as provided above of all the Releasees, and for
myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold
harmless the Releasees from any and all liabilities incident to my minor child’s
involvement or participation in these programs as provided above, EVEN IF ARISING
FROM THEIR NEGLIGENCE.
____________________________ DATE SIGNED: ____/____/_____
(Parent/Guardian Signature)
Emergency Phone Number: _________________________
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