Memphis Lacrosse League

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Pre Game October 19-November 11, 2010

Form

1. Last Name*

2. First Name*

3. School You Attend

4. Gender*

5. Street Adddress*

6. City*

7. Zip Code*

8. Emergency Phone Number (xxx-xxx-xxxx only)*

9. Date of Birth (MM/DD/YY)*

10. Email Address*

11. Years of Experience*

12. Grade (Fall 2010)*

13. Position you play*

14. US Lacrosse Membership Number (must have www.uslacrosse.org)*

Thank you for registering for the Memphis Lacrosse League Event. This confirms you have registered for the event. This is only a confirmation of registration you will need to mail a check to: 6645 Poplar Ave #208, Germantown, TN 38138 or drop a check off at our store. Thanks

15. Release and Waiver of Liability (Read Carefully before submitting)*

2009-2010 Memphis Lacrosse Indoor League


IN CONSIDERATION of being permitted to enter for any purpose any Restricted Area(s) (herein defined as the area(s) to which admission by general public spectators is prohibited), or being permitted to compete, officiate, observe, work for, or for any purpose participate in any way in the event taking place in such Restricted Area(s) (the “Event”), I AGREE:

1.	I have, or will immediately upon entering any of such Restricted Area(s), and will continuously thereafter, inspect such Restricted Area(s) and all portions thereof which I enter.  If at any time, I feel anything to be unsafe, I will immediately leave the Restricted Area(s) and refuse to participate.
2.	I UNDERSTAND that:
(a)	There are RISKS AND DANGERS associated with participation in sports activities and events including but not limited to those of BODILY INJURY, PARTIAL AND/OR TOTAL DISABILITY, PARALYSIS AND DEATH (“RISKS”);
(b)	The SOCIAL AND ECONOMIC LOSSES and/or damages which could result from those risks and dangers COULD BE SEVERE;
(c)	These risks and dangers may be caused by THE NEGLIGENCEOF THE RELEASEES’ NAMED BELOW or the negligence of others.
(d)	There may be OTHER RISKS NOT KNOWN TO ME or not immediately foreseeable at this time.
3.	I ACCEPT ALL RISKS AND FULL RESPONSIBILITY FOR THE LOSSES AND /OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH however caused and whether caused in whole or in part by the NEGLIGENCE OF THE ‘RELEASEES’ NAMED BELOW.
4.	I HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the promoters, US Lacrosse, Memphis Lacrosse, Stickhead Lacrosse LLC other participants, operators, officials, and persons in any restricted area, sponsors, advertisers, owners, and lessees of premises used to conduct the Event and each of them, their directors, officers and employees, all of the purposes herein referred to as “Releasees”, FROM ALL LIABILITY TO ME, my personal representatives, assigns, heirs and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN MY DEATH, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE while I am in or upon the Restricted Area(s), and/or, competing, officiating, observing, working for, or for any purpose participating in and/or traveling to or from the Event.

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES’ FAULT AND SIGN I VOLUNTARILY AND WITHOUT INDUCEMENT.

I AGREE

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