·       I hereby authorize KK Athletics and The Long Island Elite lacrosse Club, LLC to act on my behalf according to its best judgment in any medical emergency and permission to request medical treatment as necessary to insure the well being of the applicant. I verify to the best of my knowledge that the above named applicant is physically able to participate in the program activities. I, the undersigned, waive and forever discharge, Long Island Elite Lacrosse Club, LLC, its staff, officer’s agents, representatives, employees and successors from all rights and claims for damages to person or property while participating in the Suffolk County Lacrosse League.

 

________________________________________________________________________

Signature                             Parent/Guardian                         Print Name                   Date

 

Coverage for all expenses due to injury is the responsibility of the participant's parent and guardian. All participants require medical insurance. Please indicate your Health Insurance Plan below.

 

I have required insurance.

 

Health Insurance Co.: _______________________________________

 

Policy No.: _______________________________________________