York College Boy’s Lacrosse Camp
June 18th – June 20th 2012
Kinsley Field on The Campus of York College of PA.
Cost: $200.00 (Checks Only)
Registration Form
Name:
Address: (City, State, Zip)
Position:
Grade (As of Fall 2011):
Contact Phone Number:
Contact e-mail:
Jersey Size: M_____ L______ XL_______ XXL
Amount Enclosed:
_______________$200 Checks Payable to C4LACROSSE
PLEASE FILL OUT INSURANCE AND WAIVER FORM AND ATTACH
TO APPLICATION.
RELEASE AND COVENANT NOT TO SUE
This is a legally binding release and covenant not to sue given by me,
__________________________________(print full name) to C4 Lacrosse and or York College.
In consideration for receiving permission to participate in the York College Lacrosse Camp,
I am freely andvoluntarily entering into this release and covenant not to sue. I fully recognize that there are dangers and risks to which I may be exposed by participating in the York College Lacrosse Camp. Examples of these risks and dangers include the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event and related sports conditioning activities.
I understand that York College and C4 Lacrosse does not require me to participate in thisactivity, but I want to do so despite the dangers and risks and despite this release and covenant not to sue.
I therefore agree to assume and take on all of the risks and responsibilities inany way associated with this activity. In consideration of and return for being permitted to participate in this activity, and for the services, facilities and other things provided to me by C4 Lacrosse or York College in this activity, I HEREBY RELEASE YORK COLLEGE (and its trustees, employees or agents) FROM ANY AND ALL LIABILITY, CLAIMS AND ACTIONS THAT MAY ARISE FROM INJURY OR HARM TO ME, FROM MY DEATH OR FROM DAMAGE TO MY PROPERTY IN CONNECTION WITH THIS ACTIVITY. I
UNDERSTAND THAT THIS RELEASE AND COVENANT NOT TO SUE COVERS LIABILITY, CLAIMS AND ACTIONS CAUSED ENTIRELY OR IN PART BY ANY ACTS OR FAILURE TO ACT OF YORK COLLEGE or C4 Lacrosse (or its trustees, employees or agents), INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE, MISTAKE OR FAILURE TO SUPERVISE BY YORK COLLEGE.
I recognize that this release and covenant not to sue means I am giving up, among other things, rights to sue York College or C4 Lacrosse for injuries, damages or losses that I may incur. I also understand that this release binds my heirs, executors, administrators and assigns as well as myself.
I have read this entire release and covenant not to sue, I fully understand it, and I agree to all of the terms and conditions as stated herein. Participant Waiver (Signature is required in order to participate) In consideration of my participation in the York College Lacrosse Camp sponsored events and activities, I agree to the following:
1. Medical Attention: I hereby give my consent to the York College Of PA. 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 my participation in York College Lacrosse Camp sponsored or sanctioned events.
2. Readiness to compete: I will only participate in those conditioning or activities in which I believe I am physically and psychologically prepared to participate.
Participant Primary Medical
Insurance Carrier: _______________________________ Policy #_______________________
Signature of
Participant______________________________________________
FOR ANY PARTICIPANT WHO IS NOT
YET 18 YEARS OF AGE: As a legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child to participate the York College Lacrosse Camp, and I accept each of the above conditions.
Signature of
Guardian_____________________________
Printed Name____________________________________ Date_____________________________
Brandon Childs
York College Men’s Lacrosse
York College
441 Country Club Road.
York, PA. 17403
717-880-6200
or e-mail to: bchilds2@ycp.edu
