Name *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

I acknowledge that my daughter is a current member of U.S. Lacrosse and that I will make sure her membership remains current as long as she is a rostered player for the Eastern Shore Lacrosse Club. * *

I Accept

Parent Full Name *

First Name

Last Name

ESLC EASTERN SHORE LACROSSE CLUB Waiver, Release, and Indemnity Agreement: As the parent and/or legal guardian of the below identified minor child (hereafter, “Participant”), in consideration of Participant’s being allowed to participate in any activities of the Eastern Shore Lacrosse Club, LLC (“ESLC”), and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby undertake and agree as follows: COVID-19 WARNING: Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Eastern Shore Lacrosse Club programs or accessing facilities used by Eastern Shore Lacrosse Club could lead to the risk of contracting COVID-19. Eastern Shore Lacrosse Club in no way warrants that COVID-19 will not occur through participation in Eastern Shore Lacrosse Club programs or accessing facilities used by Eastern Shore Lacrosse Club. 1. I hereby waive and release, discharge, and agree to indemnify, ESLC, Cape Henlopen School District, and each of them, and any officers, directors, coaches, independent contractors, employees or assistants of those entities, and each of them, from any liability, including, but not limited to, liability as to the result of negligence, and/or any injury, accident or illness, including but not limited to COVID-19, incurred by Participant while participating in any ESLC activities. 2. I fully understand that there is a risk of injury to participant participating in competitive lacrosse activities, such as a tryout, and for participant, do hereby knowingly and voluntarily assume all risk of such injury or accidents. 3. I will be financially responsible for any medical attention or cost of transportation needed in association with Participant’s participation with ESLC or resulting from an injury received while Participant is practicing and/or playing lacrosse, or participating in any ESLC activities. 4. I hereby give my consent to ESLC and to any agent acting on its behalf to secure and provide any medical attention for Participant which might be necessary and urgently needed during a time when I cannot be contacted in person or by telephone. 5. I accept full responsibility for any medical expenses incurred on behalf of the Participant under the conditions described above. 6. The medical insurance information provided on Participant’s Player Participation Form shall be for the insurance coverage for any medical treatment. 7. I understand and agree that ELSC’s Directors, Coaches shall retain the right to exclude any participant from taking part in any activity when, in their considered judgment, Participant is not yet ready to take part in safely, or where Participant’s involvement at the time in question may interfere with the health or safety of others. 8. I hereby give my permission to ESLC to use photographs, written statements (such as testimonials), and videos of participants for promotional purposes. 9. I understand that all tuition and fees due to ESLC are payable when and as specified, and that Participant may not enter and/or continue to attend any ESLC activities unless all tuition and fees are paid and all forms required by ESLC are complete and up to date. 10. A $25.00 fee will be assessed for late-payments and/or any returned checks. I HAVE READ THE FOREGOING, FULLY UNDERSTAND THE PROVISIONS OF SAME, AND FOR MYSELF AND FOR PARTICIPANT, THE IDENTIFIED MINOR CHILD BEING REGISTERED, AGREE TO BE BOUND THEREBY *

I Agree