MIAMI SHORES LIGHTNING LACROSSE

WAIVER OF LIABILITY, MEDICAL RELEASE, AND INDEMNIFICATION AGREEMENT

I hereby voluntarily permit my child_____________________________________________________, to participate in the
(Please Print Child’s Name)
Miami Shores Lightning Lacrosse program.

 I UNDERSTAND AND FULLY ACCEPT THAT THERE ARE RISKS INVOLVED IN SPORTS, AND THAT ACCIDENTS AND INJURIES ARE COMMON AND ARE ORDINARY OCCURRENCES OF SPORTS. I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH AND VERIFY THIS STATEMENT BY CHECKING THE BOX.

As consideration for being permitted by the Miami Shores Lightning Lacrosse to participate in this activity, I hereby release and hold harmless The Miami Shores Lightning Lacrosse, volunteers, designated coaches, and program officials and supervisors from all liability, and from all actions or claims that I or my child now or hereafter have for damage or injury to my child, or to any person or property, resulting from the negligence or other acts of any employees or volunteers in connection with my child’s participation. I further agree that this waiver, release, and assumption of risks are to be binding on the heirs and assigns of the undersigned. 

I further agree to indemnify and to hold Miami Shores Lightning Lacrosse (its officers, employees, agents, and volunteers) free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of any injury and/or property damage that I or my child may cause or sustain while participating in this activity.

In the case of a medical emergency, I hereby give permission to Miami Lightning Lacrosse and Volunteers to order treatment for my child, including any necessary medical treatment and x-rays. I also hereby give permission to Miami Shores Lightning Lacrosse Volunteers to disclose the information contained on the Emergency Medical Card to medical personnel. I understand that an attempt will be made to reach me by phone when a diagnosis is completed. I agree to pay all medical, hospital, or other expenses which my child or I may incur as a result of such treatment.

Miami Shores Lightning Lacrosse does not disclose your nonpublic personal medical and financial information, except as required or permitted by law. The Miami Shores Lightning Lacrosse also does not provide any medical or other insurance protection outside of what is provided in the US Lacrosse Membership.

I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND THE MIAMI SHORES LIGHTNING LACROSSE AND SIGN IT OF MY OWN FREE WILL.

NAME                                                                                                               Date

msll_waiver_of_liability.pdf