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Trilogy Providence Tournament Release of Liability Waiver

I, (parent/guardian) hereby request you (Trilogy Lacrosse, LLC, TRILOGY) accept this agreement (Agreement) for my childs enrollment in the TRILOGY event(s) listed on this form (Events). In consideration of TRILOGYS acceptance of this Agreement, I hereby agree to release, hold harmless, and indemnify Trilogy Lacrosse, LLC, and all of their respective owners, agents, employees, sponsors, representatives and assigns, from and for any and all claims resulting from any injuries or death sustained by my child while participating in the Events, or in traveling to or from the Events. I acknowledge that lacrosse is a contact sport, and understand that, although rare, there is a risk of serious injury or death associated in playing the sport. I hereby give permission to the coaches, training staff, and other medical professionals to provide medical care as deemed necessary to my child in case of any injury or illness. Photos and video taken of my child while participating at the Events may be used in and for any TRILOGY publications and advertisements. I warrant and represent that I have the authority to sign this Agreement on behalf of my minor child. Signing this Agreement, and registration of my child in the Events, shall act as my consent for any such advertising usage. I acknowledge and agree that I am responsible for outfitting my child with the appropriate equipment (stick, gloves, elbow pads, shoulder pads, mouth guard and helmet) for the Events, and I agree that my child will wear their helmet at all times during the Events.

First Player Name

First Name*

Last Name*

Phone*
First Player Date of Birth*
I certify that I am 19 years of age or older
First Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
First Player Signature*
Second Player Name

First Name*

Last Name*
Second Player Date of Birth*
Second Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Third Player Name

First Name*

Last Name*
Third Player Date of Birth*
Third Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Fourth Player Name

First Name*

Last Name*
Fourth Player Date of Birth*
Fourth Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Fifth Player Name

First Name*

Last Name*
Fifth Player Date of Birth*
Fifth Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Sixth Player Name

First Name*

Last Name*
Sixth Player Date of Birth*
Sixth Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Seventh Player Name

First Name*

Last Name*
Seventh Player Date of Birth*
Seventh Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Eighth Player Name

First Name*

Last Name*
Eighth Player Date of Birth*
Eighth Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Ninth Player Name

First Name*

Last Name*
Ninth Player Date of Birth*
Ninth Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Tenth Player Name

First Name*

Last Name*
Tenth Player Date of Birth*
Tenth Player Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Player Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email
Check to receive pre-tournament information, and be added to Trilogy Lacrosse Mailing List.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 19 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 19 years of age or older
Parent or Guardian's Team
Select Club Team You Are Playing for This Tournament*
Select Player High School Graduation Year*
Select Player Position*

Type Player Jersey Number (if you do not yet have your jersey number type TBD) *

Type Player US Lacrosse Number. *NOTE: All participants must be a registered US Lacrosse Member and provide their Member Number on this form. If you are not already a member go to uslacrosse.org/membership and register, and then complete this Waiver. *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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