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GSE Waiver



Instructions: Each Player and their Parents/Guardians should read the statement below before completing and signing this Waiver & Release Form.
Agreement: In consideration for the right to play in a Granite State Elite Sports, LLC, Program, event, travel and activities, the undersigned acknowledges, appreciates, and agrees that:

 1.) Readiness to Compete: Voluntarily and of my own free will, I elect to participate as a member. I will only participate in competitions and activities for which I believe I am physically and psychologically prepared to compete.

2.) Medical Attention: I hereby give my consent to Granite State Elite Sports, and the host organization of any event to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted through the course of my participation in sponsored activities.

3.) Consent to use of Photographic or Video images: I hereby grant Granite State Elite Sports, its agents and representatives, full and comprehensive rights to use photographs or other types of media to promote the Granite State Elite program.

4.) Waiver & Release of Liability: I am fully aware of and appreciate the risks associated with participation in sports, including the risk of catastrophic injury, paralysis and even death, as well as other types of damages and loss. I further agree on behalf of myself, my heirs, personal representatives, and next of kin, that Granite State Elite Sports, the host organization, and sponsors of any event, along with their coaches, volunteers, employees, agents, officers and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event(s). My signature below is my acknowledgement that I have read and understood every provision of this Waiver and Release of Liability, and that I agree to abide by it.

(Leave nothing blank)

Print Players Name___________________________________________

Players Signature______________________________ Date__________

USA Lacrosse/Field Hockey Number______________ Exp. Date________

Street Address_______________________________________________

City___________________________ State_______ Zip Code__________

Print Parents Name____________________________________________

Parents Signature_______________________________ Date__________

Health Ins. Provider_____________________ Policy#________________

E-Mail Address_______________________________________________

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