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Trilogy Lacrosse 2023 Winter Western Winners Showcase

Player Information Form/Waiver



Medical Release:

I, (parent/guardian) hereby request you (Trilogy Lacrosse, LLC, TRILOGY) accept this agreement (Agreement) for my child's enrollment in the TRILOGY event(s) listed on this form (Events). In consideration of TRILOGY acceptance of this Agreement, I hereby agree to release, hold harmless, and indemnify Trilogy Lacrosse, LLC, Pomona College 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.If there is an injury/ emergency that requires medical attention outside the scope of the Athletic Trainer, the players family will be notified immediately and an action plan discussed with the Athletic Trainer onsite. I hereby give permission to the coaches, athletic 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, goggles and mouth guard for girls) for the Events.

I certify that I have read and explained all of the provisions in this waiver to my child including the risk of possible exposure to infectious diseases such as COVID-19. My child understands and accepts these risks and responsibilities to adhere to the policies and procedure required by TRILOGY to mitigate these risks. 

I acknowledge that I have read this Release, fully understand its content and have signed below of my own free will. 

I Agree




Please select who will be participating...
Minor
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First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Player Information

The following information will be used for the college coach roster book


Player Cell Phone # *

Player Email *
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Insurance

Insurance Carrier*

Insurance Policy Number*
Additional Health Information
Does participant have asthma that requires use of an inhaler?*
Does Participant Have Any Food or Non-Food Allergies?*

If Yes, List Food or Non-Food Allergies i.e bee stings, penicillin. Enter "None" if no. *

Please list any other medical information or medication you would like us to be aware of? i.e. Serious Sports Injuries, Diabetes, Seizures. Enter "None" if no. *
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.


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*

Relationship*
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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