COVID-19 Return to Play Waiver & Release
Fort Bend Panthers Lacrosse Club, Inc.
By my signature below, I, on behalf of myself, my personal representatives, assigns, heirs, and next of kin, do hereby agree to indemnify, release and hold harmless the Fort Bend Panthers Lacrosse Club, Inc. (“FBLAX”), Dynamic Sports Management Inc. its employees, directors, officers, operators, volunteers, affiliates, vendors, invitees, coaches or agents (the "Released Parties") from any and all liability, claims, demands, actions or causes of action, of any kind or nature, arising out of or related to any damage, illness or injury, regardless of severity, resulting from the participating, attending and/or engaging in any FBLAX activity (“Claim”). I hereby expressly waive any right of action or any defense I may have against the Released Parties in consideration of my participation, attendance and/or engagement with FBLAX. I hereby acknowledge that I know of no medical reason that would preclude me from participation, attendance and/or engagement with FBLAX.
I understand that by brining my child, parent and/or any other family member or friend to FBLAX activities that there could be a reasonable, foreseeable risk that he/she could be exposed to communicable and contagious diseases, such as COVID-19, and/or contract or be around others that are ill, whether they are symptomatic or not. I have had the opportunity (and am hereby advised) to talk to my primary healthcare provider about the risks associated with FBLAX activities and I understand and assume responsibility for those risks. I will follow all policies, procedures, and respect the directives and abide by the requirements to return to play. I represent that the participant (including but not limited to my child and/or ward) is in good physical condition, does not have any medical, physical or mental condition that could result in injury or illness for others. I specifically assume the risk of the participant (including but not limited to my child and/or ward) participating, attending and/or engaging in FBLAX activities and indemnify, release and hold harmless FBLAX and the Released Parties.
In consideration of being afforded the opportunity to participate in FBLAX activities, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the undersigned and/or the undersigned’s parent or legal guardian (for any minor participants, invitees or engaged persons), does for and on behalf of himself, his heirs, executors, administrators, successors and assigns agree to and hereby does indemnify, release, acquit and forever discharge and hold harmless FBLAX and Released Parties, including but not limited to, negligence, gross negligence, willful or intentional conduct, personal injury damages, medical or hospital bills, lost wages, property damages, judgements, levies and executions whether known or unknown, liquidated or unliquidated, fixed or contingent, direct or indirect which the undersigned and his heirs, executors, administrators, successors and assigns may have, against FBLAX and Released Parties arising out of my participation, attendance and engagement in FBLAX activities.
It is my express intention, and the express intention of the Released Parties, that the release provided for in this Agreement release the Released Parties from the consequences of the acts or omissions of the Released Parties, including acts of negligence, GROSS NEGILIGENCE, WILLFUL OR INTENTIONAL CONDUCT, PERSONAL INJURY DAMAGES, MEDICAL OR HOSPITAL BILLS, LOST WAGES, PROPERTY DAMAGES, JUDGEMENTS, LEVIES, EXEUCTIONS or alleged negligence, and including where same are the contributing cause of the claim. To the Greatest Extent permitted by Applicable Law, FBLAX Shall NOT BE HELD LIABLE IF I CONTRACT or am exposed to communicable and contagious diseases, such as covid-19. I voluntarily assume the risk that I may be exposed to or infected by such virus or disease and I release FBLAX from all liability for any injury, illness, disability, death, damage, loss, or claim related to or arising out of the COVID-19 virus stemming FROM my PARTICIPATION, ATTENDANCE AND/OR ENGAGING IN FBLAX ACTIVITIES IN ANY FORM.
I understand this release is binding on myself and my heirs, executors, administrators, successors and assigns and that FBLAX will deny my participation in FBLAX activities until this release is executed by myself and on behalf of any minor participants, invitees or engaged persons and all terms are hereby accepted.
I understand that if my child is a minor, then I acknowledge each and every matter stated herein and concur on behalf of myself and my minor child.
I acknowledge that this waiver and release of liability is being signed by me voluntarily, without coercion, duress, or undue influence and with full knowledge of its terms and effects. I certify that I have reached the age of majority, and that I have read the above waiver and release of liability and fully understand its contents.
1st Parent Name (First and Last): __________________________________
1st Parent Signature (First and Last): ________________________________
2nd Parent Name (First and Last): __________________________________
2nd Parent Signature (First and Last): _______________________________
Sibling #1 Name (First and Last): ____________________________________
Sibling #2 Name (First and Last): ____________________________________
Sibling #3 Name (First and Last): ____________________________________
Sibling #4 Name (First and Last): ____________________________________
Participant Name (First and Last): __________________________________
Participant US Lacrosse Number: ___________________________________
Participant US Lacrosse Number Date of Expiration: _____________________
Date: _________ ____, 2020
COVID-19 Return to Play Waiver & Release