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Waiver/Release for Communicable Diseases Including COVID-19

Waiver/Release for Communicable Diseases Including COVID-19

                    

In consideration of being allowed to participate in a US Lacrosse, Inc., Comet Girls Lacrosse events , the undersigned acknowledges, appreciates, certifies and agrees that:

My participation includes possible exposure to and illness from infectious diseases, including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness, injury, and death does exist.

If I have a pre-existing health condition, exposure to COVID-19, or any other infectious disease may be more likely to cause serious illness, injury, or death.

USL cannot ensure that all other participants, including coaches and volunteers, are taking precautionary measures to mitigate risks to ensure the health and safety of other participants, coaches, and volunteers, and therefore, participation in a USL Event involves risk of exposure to infectious disease; and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

I certify that I have not recently tested positive for, and am not exhibiting symptoms of COVID-19, which include a cough, shortness of breath or difficulty breathing, loss of taste or smell, headache, chills, muscle or body aches and/or sore throat.

I certify that I do not have a household family member/roommate who has recently tested positive for or exhibited the above-referenced symptoms of COVID-19.

I willingly agree to comply with all recommendations provided by USL to ensure safe play. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest coach, staff member or volunteer, or official immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS USL, and their officers, officials, agents, and/or employees, other participants, volunteers, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

First Players Name

First Name*

Middle Name

Last Name*

Phone*
First Players Date of Birth*
First Players Signature*
Second Players Name

First Name*

Middle Name

Last Name*
Second Players Date of Birth*
Third Players Name

First Name*

Middle Name

Last Name*
Third Players Date of Birth*
Fourth Players Name

First Name*

Middle Name

Last Name*
Fourth Players Date of Birth*
Fifth Players Name

First Name*

Middle Name

Last Name*
Fifth Players Date of Birth*
Sixth Players Name

First Name*

Middle Name

Last Name*
Sixth Players Date of Birth*
Seventh Players Name

First Name*

Middle Name

Last Name*
Seventh Players Date of Birth*
Eighth Players Name

First Name*

Middle Name

Last Name*
Eighth Players Date of Birth*
Ninth Players Name

First Name*

Middle Name

Last Name*
Ninth Players Date of Birth*
Tenth Players Name

First Name*

Middle Name

Last Name*
Tenth Players Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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