2019 Great Western Indoor Lacrosse League Registration
Please fill out the following forms leaving no areas blank.
Player Information
Players First Name *
Your answer
Players Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Please use this format - XXX-XXX-XXXX
Your answer
Parent Email *
Your answer
Players Email *
Your answer
Grade *
What grade are you in as of September 1st, 2019
Date of Birth *
Use this format - ( 00/00/0000 )
Your answer
Name your Indoor Position *
Are you a goalie or a field player?
School / Team *
What Team do you play for in the Spring?
Your answer
Name your regular Lacrosse Position *
What position do you play in field lacrosse?
Would you like to register for the Practice Module for an additional $100 *
HS - This would give you 6 practices on Thursdays through the season... 3rd thru 8th grades only
Are you interested in playing for the San Diego Spiders Tournament Team in January 2020 *
Sixteen day committment. Practices beginning on January 20th and finishing on February 9th. 12 Practcies and 2 tournaments.
Great Western Indoor League Player Release Form
I understand that:
1) My child is in good physical condition and has had a physical examination in the last 365 days;
2) I am hereby waiving and releasing Great Western Lacrosse, the Great Western Lacrosse indoor lacrosse League, its Director and all staff, the Poway Sportsplex, and any sponsors, of any and all liability for injuries incurred by my child while playing in the league even if arising from negligence;
3) I understand that this League is run at a facility with artificial grass and that a $3.00 fee is charged by the facility upon entering, for any person 16 years of age or older;
4) I am aware that this league is a "play at your own risk" league and that I must have primary medical insurance coverage that blankets my child, the participant;
5) I am aware that this is a "no hit" league, I have discussed this with the participant. I am also aware that any disregard of the rules will result in expulsion from the league without refund and that the Director, the Coaches and/or the Referee have the irreversible right and judgment to expel any player.
6) I am aware that all the coaches work for Great Western and not for the individual teams.
7) I understand that the Great Western Indoor Lacrosse League does not allow disrespect or negativity from the fans/parents watching the games, either towards opponents, the referees or other fans/parents.

In the event that my child is injured and I am unable to give parental consent, I hereby authorize the Physician/Hospital Staff at any Hospital to provide care to include diagnostic procedures and medical treatment as necessary to my child, who is a minor.
By signing below, I am entering into a contract willfully and without coercion. I am aware that the League fee of $200.00 (and Practice Fee of $100) is non-refundable for any reason after the first game, not even for an injury.
Parent Signature *
Your answer
Date *
Your answer
Parents Phone Number *
Your answer
Great Western Indoor League Player Waiver & Release of Liability Form
Great Western Lacrosse Programs

In consideration of being allowed to participate in any way in a Great Western Lacrosse athletic sports programs, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury from activities involved in this program is significant, including the potential for permanent injury and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and, assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Great Western Lacrosse Company, its Director, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event {“RELEASEES”}, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without inducement.

This is to certify that I, as parent / guardian with legal responsibility for this participant, do consent and agree to his release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE.

Parent Signature *
Your answer
Date *
Your answer
US Lacrosse Participant Waiver & Release of Liability
For participation in the Great Western Indoor Lacrosse League.

1.) each Player should read the statement below before completing and signing this Waiver & Release Form.
2.) Parents / Guardians should read the statement below before completing this Waiver & Release Form.

In consideration of my membership in US Lacrosse and of my participation in the sponsored activities of the Great Western Indoor Lacrosse League, I acknowledge, agree to and understand that:

1.) Readiness to Compete: Voluntary and of my own free will, I elect to participate in the Great Western Indoor Lacrosse League. I will only participate in those US lacrosse competitions and activities sponsored by Great Western Lacrosse for which I believe I am physically and psychologically prepared to compete.

2.) Rediness to Compete: I hereby give consent to US Lacrosse and to Great Western Lacrosse, the Poway Sportsplex and the hostr organization of any US Lacrosse sponsored event to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted through the course of my participation in sponsored lacrosse activities.

3.) Waiver & Release of Liability: I am fully aware of and appreciate the risks associated with participation in a lacrosse event, including the risk of catastrophic injury, paralysis and even death, as well as other types of damages and loss. I further agree on behalf of myself, my heirs, and personal representatives, that US Lacrosse, Great Western Lacrosse, the Poway Sportsplex, the host organization, and sponsors of any US Lacrosse event, along with their coaches, volunteers, employees, agents, 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(s). My signature below is my acknowledgement that I have read and understood every provision of this Waiver and Release of Liability, and that I agree to abide by it.
Player Signature *
Your answer
US lacrosse Membership Number *
All players MUST be members of US Lacrosse to participate in this league. Omit the leading zeroes. Should be 7 numbers.
Your answer
US lacrosse Membership Expiration Date *
All players MUST be members of US Lacrosse to participate in this league. Use this format - X/X/20XX
Your answer
Parent's/Guardian's Signature *
Your answer
Date *
Your answer
Parent Email *
Your answer
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