Kitchener - Waterloo Minor Lacrosse Waiver Form 2022
Release of Responsibility Form

Must be completed to confirm registration.
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I hereby give permission for my child’s participation in the Kitchener-Waterloo Lacrosse Association Programs and Leagues.  I recognize and understand all risks associated with participation in this activity and therefore agree to release Kitchener-Waterloo Minor Lacrosse Association, event organizers, the facilities hosting the clinics, box lacrosse league, rep team tryouts and games as well as their employees, sponsors and officials from any liability.

I certify that my child is in good physical and mental health. In case of a medical emergency, where I am not present, I hereby give permission for Kitchener-Waterloo Minor Lacrosse Association staff and management to seek and secure proper medical treatment for my child.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization.  COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact.  As a result, federal, provincial, and local governments and federal and provincial health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Kitchener-Waterloo Minor Lacrosse Association has put in place preventive measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19.  Further, attending the Kitchener-Waterloo Minor Lacrosse Association programs could increase your risk and your child(ren)'s risk of contracting COVID-19.    

I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the club and that such exposure or infection may result in personal injury, illness, permanent disability, and death.  
I understand that the risk of becoming exposed to or infected by COVID-19 at the Kitchener-Waterloo Minor Lacrosse Association  programs may result from the actions, omissions, or negligence of myself and others, including, but not limited to, KWMLA employees, volunteers, and program participants and their families; and I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)'s attendance at Kitchener-Waterloo Minor Lacrosse Association events or participation in Kitchener-Waterloo Minor Lacrosse Association programming ("Claims").  

On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Kitchener-Waterloo Minor Lacrosse Association, its employees, volunteers, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto.  I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Kitchener-Waterloo Minor Lacrosse Association, its employees, volunteers, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Kitchener-Waterloo Minor Lacrosse Association program.

I give Kitchener-Waterloo Minor Lacrosse Association  permission to:    

1) Provide your contact information to Kitchener Waterloo Lacrosse Association  coaches, volunteers and staff so they can communicate with you.  
2) Have your child videotaped or photographed by Kitchener-Waterloo Minor Lacrosse Association  coaches, volunteers and staff and use these photos and videotapes for promotional purposes only.      
3) Continue to send email communications to my attention advising of program updates and promotions.

By checking the box below and providing my name below, I acknowledge that I have read and understand this form and further understand the terms herein are contractual and not a mere recital.   All players participating must have their parent or guardian complete and submit this waiver prior to participating. Players will not be allowed to play unless we have a digital record of this waiver. No exceptions.
Player Name *
Parent / Guardian Name *
Response *
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