Middle Country Boys Youth Lacrosse A/K/A Mad Dogs Lacrosse, Inc.  Release & waiver

I do hereby fully release and discharge Middle Country Boys Youth Lacrosse A/K/A Mad Dogs Lacrosse, Inc.  its officers, directors, coaches, assistants, referees and other agents or persons engaged in the activities of Middle Country Boys Youth Lacrosse A/K/A Mad Dogs Lacrosse, Inc.  from any and all claims for injuries, damages or loss which I may have or which may occur to me on account of my child’s participation in this program.

I further agree to indemnify and hold harmless and defend Middle Country Boys Youth Lacrosse A/K/A Mad Dogs Lacrosse, Inc and its officers, directors, coaches, assistants, referees and other agents or persons engaged in the activities of Middle Country Boys Youth Lacrosse A/K/A Mad Dogs Lacrosse, Inc  from any and all claims resulting from injuries, damages or loss sustained by anyone, and arising out of, connected with or in any way associated with my conduct and the activities of this program.

I further understand that terms such as “participation”, “program” and “activities” referred to in this release include all exercised and physical movements of any nature while I am participating in this program and further include the provision of or failure to provide proper instruction or supervision, the use and adjustment of any and all equipment, machinery, apparatus, and anything related to my use of the services, facilities, or premises involved in this program, and transportation to and from any events. The risk of injury from the activities involved in this lacrosse program are significant, including the potential for permanent paralysis and death, and while particular rules and personal discipline may reduce this risk, the risk of serious injury does exist.

I also understand that Middle Country Boys Youth Lacrosse A/K/A Mad Dogs Lacrosse, Inc is not affiliated with the Middle Country School District.

I understand the nature of the program for which I am registering, and have read and fully understand this Waiver and Release.  I further understand any advisement or warnings of the particular risks of this program and I therefore acknowledge that they are part of this Waiver and Release.

ON BEHALF OF MY CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISK, both known and unknown, EVEN IF ARISING FROM NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation.

MY CHILD IS WELL AND ABLE TO PLAY THIS SPORT.  I WILL ADVISE THE COACH OF ANY CHANGES IN MY CHILD’S HEALTH STATUS.

By submitting this registration form, I acknowledge that I have read and agreed to this Release & Waiver for the child(ren) I am responsible for and have authority to act on his/their behalf’s.