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BOYS LACROSSE TOURNAMENT

June 15, 2019

WAIVER & RELEASE FORM

I, being the legal guardian of the individual named on this form, certify that he is in good physical condition and is capable of participating in this CAPITAL LACROSSE, LLC program. If medical attention beyond first-aid treatment is required, I understand that every attempt will be made to contact me at the emergency numbers provided. If contact with me is not possible, I give permission for medical attention to be administered. Furthermore, I hereby release, exonerate and discharge CAPITAL LACROSSE, LLC and its officers, staff, administrators, volunteers, sponsors and representatives and assigns for and against any and all injuries, damages, claims, actions, cause of actions, suits, judgments and demands incurred while participating in, or traveling to and from, this program. By signing below, I acknowledge that I have read and understand this form and further understand the terms herein are contractual and not a mere recital.

Date: October 29, 2025

Please select who will be participating...
AdultMinor
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First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Grade: *
Team Name: *
Coach's Name: *
First Participant's Signature*
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Insurance
Insurance Carrier*
Insurance Policy Number*
Travel & Hotel Information
Does your participation in the Summer Celebration necessitate an overnight stay in the Williamsburg area?*
Yes
No
How many nights will you be staying in the Williamsburg area?*
0
1
2
Hotel or resort where you will be staying
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Grade: *
Team Name: *
Coach's Name: *
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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