I, __________________________, (“Player”) certify that I am 18 years of age or older, or I must have my parents and/or legal guardians sign this form below.

 

I, player/parent and/or legal guardian, hereby state, claim and certify that a policy of general health insurance has been issued to cover me in the event I am injured in any way during my participation in the Harrisburg Lacrosse Summer League to be held from June 1, 2019 through August 30, 2019.

                I acknowledge that in consideration of my participation in the Harrisburg Lacrosse League, I, or anyone on my behalf, including any of my family members, hereby release and covenant not to sue The Harrisburg Lacrosse Club, Capital Area Lacrosse League, Meltdown Sports, Meltdown Lacrosse, Harrisburg Lacrosse, Harrisburglacrosse.com, any League’s sponsors, and/or individual team sponsors, Harrisburg Lacrosse Presidents Robert Miller and Matthew Healey, any other club officers or employees, any Harrisburg Lacrosse League team captain, and any landowner on which Harrisburg Lacrosse League games will be played, including, but not limited to, the Central Dauphin School District, Manheim Township, Manheim Township School District, Silver Springs Township (releasees) for any negligent or wrongful act on the part on any of the releasees, its agents or employees, that the releasees may engage in and which may cause personal injury or wrongful death to me arising as a result of my engagement in lacrosse activities or any activities incidental thereto, wherever, whenever or however the same may occur.  I hereby waive any and all claims resulting from any legal claims, both present and future, that I or anyone on my behalf, including any of my family members, may or could make against the Releasees for any lacrosse activities or any activities incidental thereto that I engage in.

                I acknowledge that the Harrisburg Lacrosse League will only provide lined fields, balls, goals and lacrosse officials.  I acknowledge that the Harrisburg Lacrosse League will not provide nor will it be responsible to provide any equipment for participants, any athletic trainers and/or medical personnel at any lacrosse contest, or any travel to or from the sites of competition.

                I, the undersigned Player/parent and/or legal guardian, understand this waiver is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Pennsylvania and I agree that if any portion of it is invalid, the remainder of the waiver will continue in full legal force and effect.

                I, the undersigned player/parent and/or legal guardian, hereby states that I am freely signing this agreement, that I have read this form and I fully understand it, and that I am giving up legal rights and/or remedies which may be available to me and/or my family.

 Player:                                                                 Parent or Legal Guardian if above-named player is under 18 years of age:

 

Name _________________________                Name _________________________

 

Signature ________________________            Signature ________________________            

 Date ____________________                           Date ____________________