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Palmetto Lax Classic I

Waiver and Release

I, (parent/guardian) hereby request you (Bitter Lacrosse, LLC, BITTER LACROSSE) accept this agreement (Agreement) for my child's enrollment in the BITTER LACROSSE Event(s) listed on this form (Events). I acknowledge that lacrosse is a contact sport, and understand that, although rare, there is a risk of serious injury or death associated with 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. I recognize and acknowledge that there are certain risks of physical injury to spectators at the Event(s) and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I (or my child or those in my party) may sustain as a result of attending and/or working at the Event. In consideration of BITTER LACROSSE acceptance of this Agreement, I hereby agree to release, hold harmless, and indemnify Bitter 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 arising out of or connected with my (or my child's or those in my party) attendance at the Event(s), or in traveling to or from the Events.

Photos and video taken of my child while participating at the Events may be used in and for any BITTER LACROSSE 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 Event(s), 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 for the Events.

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Graduation Year*

Team Name *

US Lacrosse # *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive event information and updates
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.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Graduation Year*

Team Name *

US Lacrosse # *
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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