Missouri State Men's Lacrosse

Jr. Bears Registration

We will use this information to better understand your players age, experience, and contact information. This will be stored with team personnel only.

Player Name*

Age*

Parent(s) Name*

Contact Info(Email and Phone Number)*

School (Currently Attending)*

Lacrosse Experience*

Position (if applicable)

Pinnie/Jersey Size*

Current US Lacrosse Membership Number*

Preferred Payment Type*

Liability/Medical Treatment/Media Waiver I HEREBY WAIVE, RELEASE, AND DISCHARGE FROM ANY AND ALL LIABILITY THE FOLLOWING ENTITIES OR PERSONS: 417 Lacrosse, Missouri State Lacrosse, Axiom Events, and/or their directors, employees, partners, sponsors, vendors, and volunteers. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, sickness, disability, personal injury, property damage, property theft, or actions of any kind which may occur to me including my traveling to and from this activity. I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned here from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I ACKNOWLEDGE that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, sickness, COVID-19 exposure, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers and spectators. CONSENT FOR MEDICAL TREATMENT:BY AGREEING, I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident, and/or illness during this activity. MEDIA RELEASE:BY AGREEING HERE, I understand while participating in this activity, I may be photographed. I understand that my photo and/video may be made visible on social media outlets, including but not limited to, Facebook, Twitter, Instagram and YouTube. Photos and/or videos may also be chosen for use in various lacrosse related marketing through various media outlets. BY AGREEING, I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREEWILL OR ON THE BEHALF OF A MINOR.

I agree*

Submit

If you feel like your form didn't go through please email us at: [email protected], and if you have any form related questions please email Jake Parker at: [email protected]