2020 Asheville/Aiken Classic Waivers

Parent/Guardian Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Emergency Phone Number *

Area Code Phone Number

E-mail *

Participants Name *

Participants Date of Birth *

Month Day Year

Division *

Club/Team Name *

Hotel Name *

Check-In Date *

Month Day Year

Check-Out Date *

Month Day Year

Medical Authorization / Liability Release

Disclaimers, Photo Release & Waiver: I hereby grant Carpetbagger Lacrosse, LLC and its successors, assigns and licensees, permission to use pictures taken of my child in publications and other media use, exhibit and display my child's picture in connection with any public materials produced by or for Carpetbagger Lacrosse, LLC. This permission is freely given without remunerative consideration of any kind.

Participant Waiver & Release: In consideration of my participation in Carpetbagger Lacrosse, LLC programs, sponsored events and activities, I agree to the following:

A. Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event and related sports conditioning activities. I further agree on behalf of myself, my heirs and personal representatives, that Carpetbagger Lacrosse, LLC, along with coaches, officials, referees, volunteers, employees, agents, sponsors, owners/lessors of premises used to conduct these events, officers and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event. Carpetbagger Lacrosse, LLC is not responsible for the participant’s fitness, abilities or equipment. Participant legal guardian represents and acknowledges that participant has adequate insurance and agree to assume full responsibility for any and all costs or expenses occasioned by an injury or medical need arising out of participation in the sport of lacrosse or use of premises, facilities or equipment.

B. Medical Attention: I hereby give my consent to Carpetbagger Lacrosse, LLC; provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of participation in Carpetbagger Lacrosse, LLC; sponsored or sanctioned events.

C. Readiness to Compete: By signing below, the participant and their legal guardian agree, they will only participate in those competitions or activities which they believe they are physically and psychologically prepared to participate.

FOR ANY PARTICIPANT WHO IS NOT YET 18 YEARS OLD: As legal guardian of this participant, I hereby verify that I have read and fully understand each of the above conditions for permitting my child to participant in any Carpetbagger Lacrosse, LLC sponsored events and activities and I accept each of the above conditions, especially the waiver and release set forth in paragraph A.

Authorization to Participate *

By Checking this Box I authorize my child to participate in the Asheville/Aiken Lacrosse Classic

I acknowledge I have read and agree to the above conditions.

Printed Name of Participant *

Printed Name of Parent/Guardian *