Boom Town/Line 39 Girl's Lacrosse Free Clinic
Please complete all questions below.  If you have more than one child attending, please fill out a registration form for each additional player.
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Player's First Name *
Player's Last Name *
US Lacrosse #
Position *
Player's Age *
Current Orginization
Example:  DLC, Bandits, Cougars, BVL.
Guardian Contact Info
First Name *
Last Name *
Phone # *
E-mail *
Waiver & Medical Release *
Waiver and Release of Liability and Registration Agreement PLEASE READ CAREFULLY BEFORE SIGNING THIS DOCUMENT.  IT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. This is a Waiver and Release of Liability and Registration Agreement (“Agreement”) for participation in the Boom Town Denver Camp, and its related programs, events, and activities (“Camp”), hosted by Boom Town Lacrosse, LLC (“Boom Town”).  The athlete (“Athlete”) is the person who will participate in the Camp.  The Athlete must complete and sign this Agreement if the Athlete is age 18 or older.  The Athlete’s parent or legal guardian must complete and sign this Agreement if the Athlete is under age 18.   I, Athlete or parent/legal guardian of Athlete, the undersigned, understand that this is a legally-binding agreement and a waiver of certain legal rights and release of liability of Boom Town and the other Releasees, as defined below.  I request permission for Athlete to participate in the Camp.  In consideration of such permission being granted, I agree, understand, warrant, and covenant as follows:  1. Voluntary Activity:  I understand and agree that the Camp will consist of numerous events and activities related to lacrosse in an outdoor environment, including but not limited to lacrosse instruction, lacrosse scrimmages and games, and various lacrosse drills.  I understand and agree that Athlete’s participation in the Camp is purely voluntary and is not required by Boom Town.  2. WAIVER AND RELEASE OF LIABILITY AND INDEMNIFICATION:  I, Athlete on behalf of myself and my heirs, representatives, successors, assigns, personal representatives, executors, administrators, and guardians, or, I, parent/legal guardian on behalf of myself and Athlete, and my and Athlete’s heirs, representatives, successors, assigns, personal representatives, executors, administrators, and guardians, hereby release, acquit, and forever discharge Boom Town and its successors, beneficiaries, representatives and assigns, and all of its members, managers, investors, officers, beneficial owners, principals, employees, volunteers, coaches, athletic trainers, physicians, administrators, faculty, trustees, agents, affiliates, and attorneys, and the respective heirs, successors, representatives and assigns, members and managers of each such person or entity (all of whom are referred to as “Releasees”) from any and all claims, losses, liabilities, demands, costs, expenses (including but not limited to attorney fees), damages, controversies, matters, actions or rights, suits of any type, whether in law or in equity, and causes of action of every kind and nature to the maximum extent permitted by law, including all claims of damage to property, and bodily, personal, and psychological injury, arising from or related in any way (directly or indirectly) to:  Athlete’s participation in the Camp and any other act, omission, trans action, event, relation ship, or facts and circumstances arising from or related in any way (directly or indirectly) to Athlete’s participation in the Camp.  I agree to indemnify, defend, and hold harmless Boom Town and the other Releasees against all damages, losses, liabilities, costs, and expenses, including attorney fees, from any and all claims, demands, suits, or actions arising from or related in any way (directly or indirectly) to Athlete’s participation in the Camp. 3. ACKNOWLEDGMENT OF RISKS:  I recognize, appreciate, and understand the dangers, hazards, and risks associated with Athlete’s participation in the Camp.  I understand that the dangers, hazards, and risks of the Camp could include damage to property and serious or even fatal bodily injuries.  I understand that the dangers, hazards, and risks of Athlete’s participation in the Camp include but are not limited to:  concussion, broken bones, dehydration, exposure to inclement weather, hypothermia or hyperthermia, loss or damage to personal property, injury, illness, permanent disability, death, falling, insect or animal bites, abrasions, being struck by a lacrosse ball or stick or other player, equipment malfunction, allergic reactions, and other severe injuries, illnesses, damages, losses, or harm that may result from any such incident.  These are only some, but not all, of the dangers, hazards, and risks associated with participation in the Camp.  A complete list of the dangers, hazards, and risks is not possible, and there may be other dangers, hazards, and risks that are unknown, cannot be anticipated, or are not reasonably foreseeable at this time.   4. Emergency Medical Treatment:  I understand and agree that Boom Town may not have medical personnel available at the location of the Camp.  I hereby grant Boom Town permission to authorize and use emergency medical treatment, if necessary, and to transport Athlete to an appropriate facility to receive emergency medical treatment, and that such actions shall be subject to the terms and conditions of this Agreement.  I understand and agree that Boom Town and the other Releasees assume no responsibility or liability, and shall have no responsibility or liability, for any injuries, illnesses, damages, losses, or harm arising from or relating in any way (directly or indirectly) to such authorized emergency medical treatment.  5. Fitness to Participate:  I represent and warrant that Athlete is physically and mentally able to participate in all of the Camp’s programs, events, and activities and that Athlete has no health problems or physical or mental conditions that would present a risk to Athlete or to others.  6. Drug and Alcohol Policy:  I represent and warrant that I understand that Athlete shall not participate in the Camp if Athlete is under the influence of illicit drugs and/or alcohol and furthermore that if Athlete is found to be in possession of or under the influence of illicit drugs and/or alcohol during the Camp, Athlete shall be immediately removed from the Camp, at Athlete’s and/or parent’s/legal guardian’s sole expense, and shall be ineligible to return for the remainder of the Camp, without refund or compensation of any kind.  7. Insurance:  I represent and warrant that Athlete is covered by a comprehensive medical plan (i.e., health insurance) necessary to provide and pay for any and all medical costs and expenses (including but not limited to transportation costs associated with obtaining medical care).  I assume all responsibility for any and all medical costs and expenses incurred due to any injury or illness of Athlete, including if such injury or illness arises from or is related in any way (directly or indirectly) to Athlete’s participation in the Camp.  The foregoing notwithstanding, I agree to pay and shall be solely responsible for paying any and all costs and expenses related to Athlete’s medical treatment, even if such costs and expenses are not covered by insurance or if Athlete has no medical insurance.  8. Photographs:  I consent to the use by Boom Town of any type of images and recordings (including but not limited to photographs and videos) of Athlete for publicity, promotion, advertising, or other legitimate purposes.  I acknowledge that I have carefully read this Agreement and fully understand its contents.  I acknowledge that I am voluntarily executing this Agreement of my own free will after having the opportunity to consult with legal counsel of my own choosing.   I UNDERSTAND AND ACKNOWLEDGE THAT THIS AGREEMENT IS A WAIVER OF CERTAIN LEGAL RIGHTS AND A RELEASE, TO THE FULLEST EXTENT PERMITTED BY LAW, OF BOOM TOWN AND THE OTHER RELEASEES FROM, AMONG OTHER THINGS, ANY AND ALL LIABILITIES FOR ANY AND ALL INJURIES, ILLNESSES, DAMAGES, LOSSES, AND HARM OF EVERY KIND AND NATURE ARISING FROM OR RELATED IN ANY WAY (DIRECTLY OR INDIRECTLY) TO ATHLETE’S PARTICIPATION IN THE CAMP.   I ACKNOWLEDGE THAT I HAVE FULLY CONSIDERED THE DANGERS, HAZARDS, AND RISKS ASSOCIATED WITH ATHLETE’S PARTICIPATION IN THE CAMP.  I VOLUNTARILY ASSUME ALL OF THE DANGERS, HAZARDS, AND RISKS AND ACCEPT FULL RESPONSIBILITY FOR, AMONG OTHER THINGS, ANY DAMAGES, INJURIES, ILLNESSES, PERMANENT DISABILITY, OR DEATH ARISING FROM OR RELATED IN ANY WAY (DIRECTLY OR INDIRECTLY) TO ATHLETE’S PARTICIPATION IN THE CAMP.  I GIVE MY CONSENT AND APPROVAL FOR ATHLETE’S PARTICIPATION IN ALL PROGRAMS, EVENTS, AND ACTIVITIES OF THE CAMP. I represent and warrant that I am fully competent to sign this Agreement, and that I am executing this Agreement for full, adequate, and complete consideration, fully intending for myself and/or Athlete and my and/or Athlete’s heirs, representatives, successors, assigns, personal representatives, executors, administrators, and guardians to be bound by this Agreement.
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