|Consent / Waiver|
* Yes, I accept the waiver and consent to participate
* Name of Person Completing This Event Consent/Waiver Form
* US Lacrosse #
All participants are required to be covered with insurance for accidental injury. In most instances, family health insurance is adequate. Please indicate your family health insurance plan below.
* Health Insurance Company:
* Policy #:
FOR ANY PARTICIPANT WHO IS NOT YET 18 YEARS OLD
As parent or legal guardian of this participant, I hereby verify my signature below that I have read and fully understand each of the conditions under the Participant Waiver & Release section for permitting my child to participate in any lacroSSe by 3 INC. sponsored events and activities, and I accept each of the conditions, especially the waiver and release set forth above.
I/We being the legal guardian of the applicant, authorize the lacroSSe by 3 INC. and its agents permission to request treatment as necessary to sure the well being of our dependent.
* Signature of Parent/Guardian: