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Grade Entering - Fall 2019:_______

Lacrosse Experience: 
___ Never Played
___ Clinic or Camp
___ Youth Lacrosse Team
Allergies/Medical Conditions: _____________________________________________

Player Name: ________________________________________________________

Parent Email:  _______________________________________________________

Emergency Contact Name:  _____________________________________________

Emergency Contact Phone #:  ___________________________________________
Medical Waiver and Release

In consideration of my daughter's (the "Participant") participating in the Sachem Girls
Lacrosse Clinic ("Covered Events"). I agree to the following:

1)  WAIVER AND RELEASE:  I am fully aware of and appreciate the risks, including the risks of catastrophic injury, paralysis, and even death, as well as other damages and losses, associated with participation in a lacrosse event.  I agree on behalf of the
Participant, myself, my heirs, and personal representatives, that Sachem Girls Lacrosse Clinic, the host organization and the sponsor with respect to the Covered Event, together with coaches, officials and directors shall not be held liable for any injury, loss of life or other loss or damage as a result of my daughter's participation in a Covered Event.

2)  MEDICAL ATTENTION:   I hereby give my consent to Sachem Girls Lacrosse Clinic to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of the participation in Covered Events.

3)  READINESS TO COMPETE:  The Participant will only participate in those Covered Events for which I believe she is physically and psychologically prepared to compete.

Participant Name (Print):_______________________________

Parent/Guardian (Print & Sign): _______________________________

Date:  _______________
Mail to:  Sachem Girls Lacrosse Clinic, PO Box 883, Winchester, MA, 01890

Checks payable to: "Sachem Girls Lacrosse Clinic"