ࡱ> 8:7 ebjbj 4e  64$j iiiiiii@6}p~Fi06i(ii8R^iL;.6 : Walnut Creek Warrior Lacrosse PO Box 346 Walnut Creek, CA 94598 Medical Waiver Player Name:______________________________________ Team:____________________ Parent/Guardian Name:______________________________ Date:_____________________ Address:___________________________________________________ Phone Number:_____________________________________ Participation in lacrosse involves certain inherent risks and, regardless of the care taken, it is impossible to ensure the participants safety. Lacrosse requires considerable coordination, agility, and a high level of cardiovascular fitness. It involves vigorous activity for as long as an hour or more, quick bursts of speed, and alertness to fast moving objects. A variety of injuries may occur, including: minor scrapes, bruises, and sprains; more serious injuries, such as broken bones, cuts, concussions, eye injuries, and ligament strains or tears; and catastrophic injuries such as heart attack, paralysis, and death. These injuries may occur in lacrosse as a result of accidents such as slips, being struck by the ball in an unprotected area, being struck by a stick in an unauthorized fashion, colliding with another player, colliding with the goal, falling or excessive stress placed on the cardiovascular system. To help reduce the chance of injury to oneself or other participants, participants are expected to follow all official rules. All participants are expected to: wear protective pads and gloves as required by the official rules. I/We, the parent(s)/guardian(s) of hereby give permission for my/our child to participate in the WC Warrior Lacrosse program. I/We understand there are obvious known dangers/risks inherent in participation in this program (or any program of this nature), including, but not limited to, injuries sustained through a fall or loss of personal property. I/we voluntarily agree to assume such risks. In consideration of the WC Warrior Lacrosse permitting my/our childs participation in the WC Warrior Lacrosse program, based on my/our representation that my/our child is in proper physical health and condition to participate, I/we agree: 1. To assume all risk of injury to my/our child and all risk of damage to or loss of my/our childs property arising from my/our childs participation in the WC Warrior Lacrosse program. 2. To release and forever discharge WC Warrior Lacrosse, its officers, agents, and employees from any and all claims or liability for any injury, including death, and for property damage or loss which may be suffered by me or my child arising out of or in any connection with my childs participation in the WC Warrior Lacrosse program, and; 3. For my/our child, myself, our heirs, executors, administrators, and assigns to indemnify and hold harmless WC Warrior Lacrosse, its officers, agents and employees from any and all liability, claims, demands, actions, loss and damage arising out of my/our childs participation in WC Warrior Lacrosse program. AGREEMENT: I agree to follow all preceding safety rules, all posted rules, and all rules common to the sport of lacrosse. Further, I agree to report any unsafe practices, conditions, or equipment to the management. I certify that: 1) I possess a sufficient degree of physical fitness to safely participate in lacrosse, 2) I understand that I am to discontinue activity at any time I feel undue discomfort or stress, and 3) I will indicate below any health related conditions that might affect my ability to play lacrosse and will immediately verbally inform the management if I feel any discomfort or stress. I have read and understand the preceding information and stipulations. I know, understand, and appreciate the risks associated with playing lacrosse and I am voluntarily participating in the activity. I assume all of the inherent risks of lacrosse, I understand in the event of medical emergency, if an EMS is called to render assistance and that I will be financially responsible for any expenses involved. I, the undersigned, parent or legal guardian of the participant, a minor, hereby authorizes the coaches or parents of team members, acting in the capacity of activity supervisors/vehicle drivers, as my Agents, to consent to medical, surgical, or dental examination and/or treatment. In case of emergency, I hereby authorize treatment and/or care at any hospital. 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