PATRIOT LACROSSE

Participation Agreement, Release of Liability,

Waiver of Claims and Assumption of Risk

This Agreement (“Agreement”) is entered into between Patriot Lacrosse Club, Inc., (“Patriot LAX”) and the undersigned,in order to participant in the Justin Bokmeyer/Patriot Lacrosse Club, Inc. clinic (the “Activity”).

Assumption of Risk. In consideration for Patriot LAX granting the undersigned permission to participate in its Activity, the undersigned hereby freely agrees to assume and accept any and all inherent, known and unknown risks of injury while participating in the Activity. The undersigned hereby further certifies that they understand and acknowledge that participation in the Activity involve certain inherent risks, dangers, and hazards which can result in serious and permanent injury, paralysis, and/or death. They further recognize and acknowledge that the risks inherent in the sport of lacrosse can be greatly reduced by conditioning, ownership of proper equipment and abiding by the rules of the game.

Release and Waiver of Claims. In consideration for allowing the undersigned to participate in the Activity, the undersigned hereby agrees as follows:

TO WAIVE ANY AND ALL CLAIMS that the undersigned has or may have in the future against Justin Bokmeyer, Patriot LAX, and any of their respective employees, volunteers, coaches, officers, managers, contractors, sponsors, advertisers, other participants in the Activity, and, if applicable, owners and lessors of premises used to conduct the Activity (the “Released Parties”) which arise from any negligent acts or omissions of any of the Released Parties or which arise from our players participation in the Activity.

TO RELEASE, INDEMNIFY AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY AND ALL LIABILITY FOR ANY LOSS, DAMAGE, INJURY, OR EXPENSE THAT THE UNDERSIGNED AND IT’S PLAYERS MAY SUFFER, OR THAT THE NEXT OF KIN MAY SUFFER, AS A RESULT OF THEIR PARTICIPATION IN THE ACTIVITY, DUE TO ANY CAUSE WHATSOEVER, INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE OR BREACH OF CONTRACT ON THE PART OF THE RELEASED PARTIES.

THE UNDERSIGNED REPRESENTS AND WARRANTS THAT THEY (I) HAVE READ THIS AGREEMENT IN FULL AND UNDERSTAND THE TERMS AND CONDITIONS CONTAINED HEREIN.

IN WITNESS WHEREOF, the undersigned has executed this Agreement on the date written below.

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Team Name (if already on a team)Age Group

Email addressDate

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Parent name (Please print)Parent Signature

Full address of player

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