UNIVERSITY LACROSSE TRAINING CENTER
@ Velocity Sports Performance
1427 Clarkview Rd. Suite 300
Baltimore, MD 21209
UNIVERSITY LACROSSE TEACHING CENTER
@ Baltimore University
Mt Washington Campus
2007 TOP 16 FALL SHOOTOUT
Lacrosse Tournament
WAIVER FORM


1.        Each of the undersigned hereby states: I am fully aware of and appreciate the risks,
including the risk of catastrophic injury, paralysis, and even death, as well as other damages and
losses, associated with participation in a lacrosse tournament or lacrosse event.  I agree on behalf
of myself, my heirs, and personal representatives that the Top 16 Fall Lacrosse Shootout
Tournament and their members, owners, directors, officers, agents, employees, and volunteers
(collectively the “Covered Parties”) shall not be held liable for any injury, damage to personal
property, loss of life or other loss or damage as a result of my participation in the Top 16 Fall
Shootout Tournament or any activities relating to the Top 16 Fall Shootout Tournament or
conducted by the Covered Parties.  It is my specific intention that none of the Covered Parties
shall have any liability whatsoever as a result, or in connection with my participation in the Top 16
Fall Shootout Tournament; I hereby waive any claims that I might have against any Covered Parties
and release all Covered Parties from any such liability; and I agree to indemnify the Covered
Parties against any such claims. In addition, I hereby give my consent to the Top 16 Fall Shootout
Tournament, the owners and operators of the Top 16 Fall Shootout Tournament Tournament and all
other Covered Parties to provide, through medical staff of its choice, customary medical/athletic
training attention, transportation and emergency medical services as warranted in the course of
my participation in activities related to the Top 16 Fall Shootout Tournament.
Not withstanding the foregoing, I understand and agree that none of the Covered Parties have any
obligation to provide any such medical/athletic training attention and the lack of any such
medical/athletic training attention or the provision thereof on a voluntary basis shall be covered by
the waiver and release set forth in this paragraph.

2.        In accordance with the NCAA bylaws, I hereby acknowledge that I have paid in full to be a
participant in the 2007 Top 16 Fall Shootout Tournament. I also acknowledge that I have not
received any discount to be a participant from any University or College or any persons
representing any University’s or College’s athletic interests.




Print Applicant’s Name: _______________________________________________

Applicant’s Signature ______________________________________Date________

Print Parent/Guardian Name ________________________________

Parent/Guardian Signature¬__________________________________Date________

Health Insurance Carrier ______________________________________

Policy #____________________________________________________
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