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Fort Wayne All Stars

Fort Wayne All Star Registration

Athlete Name

First Name

Last Name

Athlete Birthday

YYYY

Athlete Phone #

(###)

###

####

Athlete Email

Position

School

Graduation Year

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone #

(###)

###

####

Insurance Company Name

Insurance Policy Holder's Name

First Name

Last Name

Insurance Company Phone #

(###)

###

####

Insurance Policy Number

Athlete Medical Conditions

Please list any and all known medical conditions we should be aware of.

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY

Please read carefully before signing By signing below, I acknowledge that I’m choosing to participate in Hoosier Elite Lacrosse training, events, and athletic activities, and I understand and agree to the following: Understanding the Risks Lacrosse, like any sport, carries certain risks—including the possibility of serious injury, illness (including contagious conditions like COVID-19, MRSA, or the flu), or even death. While Hoosier Elite Lacrosse prioritizes safety and follows best practices, I understand that these risks cannot be entirely eliminated. Choosing to Participate I am voluntarily choosing to take part in these activities and fully accept the risks involved, whether they’re known or unknown, even if they result from the actions or negligence of Hoosier Elite Lacrosse staff or others. Responsibility and Conduct I agree to follow all program guidelines, safety rules, and instructions provided by staff. If I ever feel something is unsafe or observe a potential hazard, I will remove myself from the activity and report it to a coach or staff member immediately. Release of Liability By signing this form, I release Hoosier Elite Lacrosse—including its coaches, staff, volunteers, partners, facility hosts, and anyone involved in program operations—from any and all liability related to injury, illness, death, or property damage that may occur during my participation, regardless of cause. My Acknowledgment I’ve read and understand this waiver. I’m aware that by signing it, I’m giving up certain legal rights, and I’m doing so willingly and without pressure or promise of any kind.

Date Signed

YYYY

FOR PARTICIPANTS UNDER 18 YEARS OLD

To be completed by a parent or legal guardian As the parent or legal guardian of the participant named above, I confirm that I have reviewed the waiver and release form with my child, including an explanation of the risks involved and the importance of following all safety rules and guidelines set by Hoosier Elite Lacrosse. My child understands those risks and agrees to take personal responsibility while participating in any Hoosier Elite Lacrosse activities. By signing below, I give my full consent for my child to participate in all related programs and events. I also agree, on behalf of myself, my child, and our family, to release and hold harmless Hoosier Elite Lacrosse, its staff, volunteers, and affiliates from any liability connected to my child’s participation, including any claims related to injury, illness, or property damage—even if caused by negligence— to the fullest extent allowed by law.

Date Signed

YYYY

Emergency Contact

First Name

Last Name

Emergency Contact #

(###)

###

####

Video/Photo Release

I give permission for Hoosier Elite Lacrosse to take and use photos and/or videos of the participant for promotional purposes, including but not limited to social media, website content, and marketing materials. I understand that these images may be used without compensation and will be used solely to promote Hoosier Elite Lacrosse programs and events.

Yes

Payment Preference

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Fort Wayne All Stars