ACE Development Program Registration

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ACE Development Program Registration

ACE Development Program Registration Form - With Covid-19 Waiver

Please complete all required fields *

Name *

First

Last *

Last

Lives with: *

Primary Guardian

Address *

Address

City

State/Province

Zip/Postal

Country

Gender *

Male

Female

Other

Birthdate *

Height *

Weight *

T-Shirt Size *

Includes ACE Lacrosse T-Shirt

Years of Experience *

Are You A Goalie? *

Yes

Shoots *

Left

Right

Both

Minor Lacrosse Association *

School *

Medical Information

Medical Alert *

If none, note N/A

Family Doctor *

Name

Phone # (Include Area Code) *

Doctor's Office

Health Questions

Have you ever been diagnosed with a heart condition and been told that your physical activity should be regulated by a doctor? *

Yes

When you do physical activity do you feel chest pains? *

Yes

Have you had chest pain in the last month when you were doing physical activity? *

Yes

Have you ever felt dizziness, lost consciousness or had poor balance? *

Yes

Do you have previous problems with bones or joints that would be worsened during physical activity? *

Yes

Are you taking any prescription medication for blood pressure or a heart condition? *

Yes

PLEASE NOTE: If your answer is YES to one or more of the above questions, you will need to contact your doctor and receive authorization BEFORE being admitted into any Lacrosse New Brunswick lacrosse camps

Are you aware of ANY OTHER REASON why you should not participate in physical activity? *

Yes

Do you have any life threatening anaphylactic allergies? *

Yes

If so, please give us more information in the drop-down section below.

Allergy Information

Optional: Fill out if necessary.

Allergy (1)

Medication & Dosage Instructions

Please include all essential details.

Allergy (2)

Medication & Dosage Instructions

Please include all essential details.

Medication & Dosage Instructions

Please include all essential details.

All Other Allergies

Standard Lacrosse New Brunswick Emergency Plan:
Epi-Pen is administered, 911 is notified, Parents and/or guardians are notified, Ambulance transports child to the hospital.

Any changes required for the Standard Emergency Plan?

Yes

Please provide details about alternate emergency plan.

Do you grant Lacrosse New Brunswick staff the right to administer your child’s Epi-Pen if need be?

Yes

Location of Epi-Pen:

Emergency Contact

Primary Legal Guardian

Name *

First

Last *

Last

Relationship *

Address *

Address

City

State/Province

Zip/Postal

Country

Mobile Phone *

Include Area Code

Other *

Email Address *

May we email you Lacrosse New Brunswick notices and program information? *

Yes

Secondary Contact

Optional: Fill out if necessary.

Name

First

Last

Relationship

Pick Up Authorization

Confirm

Address

City

State/Province

Zip/Postal

Country

Mobile Phone

Include Area Code

Other

Email Address

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT (THE “RELEASE”)

PLEASE READ CAREFULLY!

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION

I, THE UNDERSIGNED, on behalf of myself and any minor child, dependent, my personal representatives, heirs, and next of kin wish to participate in the lacrosse programs offered by [INSERT NAME OF ASSOCIATION] (the “Club”) (the “Lacrosse Programs”).

With respect to participation in the Lacrosse Programs, I agree as follows:

I acknowledge that I am voluntarily participating in the Lacrosse Programs and that, as a result, employees, agents or representatives of the Club may interact with myself, my minor child, dependent, next of kin, and/or other members of my immediate or extended family.

I acknowledge that there is currently an ongoing global COVID-19 pandemic and that COVID-19 is a serious infectious disease that carries with it risk of serious personal or bodily injury including death. I acknowledge that participation in the Lacrosse Programs involves risks and dangers. I recognize that these risks may include (without limitation) illness, bodily or psychological damage and/or injury, including the risk that I, my child, dependent, next of kin or immediate or extended family may be exposed to COVID-19. I agree to assume all of these risks and all other risks incidental to participation in the Lacrosse Programs.

Accordingly, I, my heirs, executors, administrators, successors and assigns do hereby waive and release the Club and all of its affiliated, related and/or participating corporations, companies, entities and organizations, including, but not limited to LACROSSE NEW BRUNSWICK INC., and their agents, successors, servants, trustees, employees, officers, directors, assigns and independent contractors (collectively the “Released Parties”) from any and all liability for any loss, illness, bodily or psychological damage and/or injury, including the transmission of COVID-19, or expense that I may have as a result of participation in the Lacrosse Programs. I hereby waive as against the Released Parties all recourse, proceedings, demands, claims and causes of action of any kind whatsoever, whether in law or in equity, in respect of any and all loss, illness, bodily or psychological damage and/or injury, including the transmission of COVID-19, or expense which I may suffer arising out of, or in connection with, participation in the Lacrosse Programs, notwithstanding that such loss, illness, bodily or psychological damage, injury and/or expense may have been caused in whole or in part by the negligence, gross negligence or strict liability of the Released Parties or otherwise.

I also agree to indemnify, defend and hold harmless the Released Parties from and against any claims, demands, actions, causes of action, damage, loss, costs, liability or expense which may be made or brought against the Released Parties by me, my minor child, dependent or immediate or extended family member, as a result of the participation in the Lacrosse Programs, whether caused in whole or in part by the negligence, gross negligence or strict liability of the Released Parties or otherwise.

I agree to abide by all rules, including those related to cleaning and/or hygiene requirements to prevent the spread of COVID-19, of the Released Parties when participating in the Lacrosse Programs.

I agree that this release shall be governed by and interpreted in accordance with the laws of New Brunswick and Canada, as applicable. I also agree that this release is intended to be as broad and inclusive as is permitted by New Brunswick law. If any portion of this release is held invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect.

I HAVE BEEN GIVEN THE OPPORTUNITY AND HAVE BEEN ENCOURAGED TO SEEK INDEPENDENT LEGAL ADVICE PRIOR TO SIGNING THIS AGREEMENT. I HAVE CAREFULLY READ THE FOREGOING WAIVER AND RELEASE OF LIABILITY AND I UNDERSTAND AND ACCEPT THE TERMS AS DESCRIBED ABOVE.

I AM FREELY AND VOLUNTARILY SIGNING BELOW AND ASSUMING ALL OF THE AFORESAID RISKS AND HAZARDS, AND, ACCORDINGLY, MY PARTICIPATION IN THE LACROSSE PROGRAMS SHALL BE ENTIRELY AT MY OWN RISK.

I VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.

Name of Participant (Full Name) *

I have read and agree to the terms and conditions

[If Participant is under 19 or incapable of providing legal consent]

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release and Waiver of Liability and Indemnity Agreement

Name of Primary Guardian (Full Name) *

Today's Date *

I read, understand and agree to the terms of the Covid-19 Waiver *

Confirm

FACILITY SAFETY POLICY

For your Safety and to Protect our Facilities, Lacrosse New Brunswick Lacrosse Camps are SMOKE FREE on all premises!
Fighting, use of abusive language, being disrespectful to other campers, camp staff, or damaging facility property is unacceptable and may result in dismissal from the facility.
Drugs or alcohol in the facility or, on the grounds are strictly forbidden. Staff reserves the right to search bags for alcohol and drugs and to deny access to anyone who appears to be under the influence.
For health and safety reasons, no animals (except guide/aid animals) should be in the Facility.
Food or drink (except water in a closed container) should not be taken onto the floor at any time. Please clean up after yourself and dispose of waste properly.
Gum should be disposed of in the proper waste receptacles.
Photography or recording devices (including cell phones with camera and recording capability) are NOT permitted, except where authorized.
To protect yourself and our equipment please wear: athletic shoes with clean, rubber soles and cleats (no metal cleats) for the Field, and; appropriate workout wear; T-shirts, long sleeve shirts, shorts of appropriate length, athletic pants/leggings. Please, do not wear: string/ cut off/mesh tank tops, jeans, street clothing, and anything displaying inappropriate slogans or offensive text or images; cleated shoes inside the building or; perfume, cologne, body spray, or hairspray.
Please do not bring your gym bags and valuables outside of locker room areas. Lacrosse New Brunswick is not responsible for lost or stolen items; please leave valuables at home. Lost and found articles are donated to a local charity if not claimed within 7 days. Personal items (i.e. razors, hairbrushes) are disposed of for hygienic reasons.
We recommend that you stay for the entire day in order to benefit from a proper cool-down.
Only those with appropriate supervision, attire and ID, will be permitted access to the workout and training areas.
It is the campers responsibility to wear his/her helmet at all times during drills, practices, scrimmages and games.
Avoid injury when lifting weights: Before starting, warm-up properly, secure collars and check the equipment. Use proper body position and breathing technique. Use of spotters is recommended for all lifting. Return free weights and dumbbells to the appropriate racks when finished.
Unsupervised/unauthorized use of the gym is not permitted.
Spectators and pets must remain outside the fenced area. No cigarettes, food, gum, sunflower seeds or beverages on the field.

THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS. PLEASE READ IT CAREFULLY!

We request your understanding and cooperation in maintaining both your safety and health by reading and signing the following Informed Consent & Photo Release Agreement. Every person must read and understand this waiver before participating in Lacrosse New Brunswick Camp activities. We recommend that you consult your physician prior to starting an exercise or fitness program, and prior to using our Facilities.

THE WAIVER

You, the Client/Guardian, are aware that there are risks associated with participating in lacrosse activities and exercise. Your participation is completely voluntary, and you freely accept and fully assume all responsibility for all risks, and all possibilities of personal injury, death, property damage or loss to yourself or any other person as a result of your participation in camp activities. You and your heirs, next of kin, executors, administrators and assigns agree:

a) to waive all claims, known or unknown, that you have or may have in the future against Lacrosse New Brunswick, including their owners, officers, directors, agents, employees, volunteers, business operators, independent contractors and site property owners or lessees (List)

b) that Lacrosse New Brunswick are not liable or responsible for any damage to, loss or theft of your property;

c) to release and forever discharge Lacrosse New Brunswick from all liability for any personal injury, death, property damage or loss resulting from your participation in lacrosse or any other exercise activities, due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake in error of judgment by Lacrosse New Brunswick; and

d) to be liable for and to hold harmless and indemnify Lacrosse New Brunswick from all actions, proceedings, claims, damages, costs demands, including court costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with your participation in lacrosse or exercise activities.

PHOTO/VIDEO RELEASE

You, the Client/Guardian, hereby grant Lacrosse New Brunswick, their Photographer, Film Crew, and their legal representatives and assigns (including but not limited to any agency, client or publication), irrevocable permission to publish photographs/videos of my child taken at the Lacrosse New Brunswick Lacrosse Camp. These images may be published in any manner, including (but not limited to) program brochures, advertisements, periodicals, and the Lacrosse New Brunswick website. Furthermore, I will hold harmless the aforementioned photographer and film crew and their legal representatives and assigns, from any liability by virtue of minor cropping that may be required, and colour and exposure shifts that may occur in reproducing photographs/videos.

I HAVE READ AND DO VOLUNTARILY SIGN THE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISKS, RELEASE AND INDEMNITY AGREEMENT, and further state and agree that no oral representations, statements or inducement apart from the foregoing written agreement have been made. Furthermore, I permit my dependant to participate in the sport and activities of the Lacrosse New Brunswick Lacrosse Camp under the terms of the foregoing Agreement.

Cancellation/Refund Policy

If something comes up and you have to cancel your registration, for any reason, please do so in writing and within 48 hours of your camp start date. We would be happy to give you a 100% credit of all fees paid. Not showing up for any reason other than the above specified, will not entitle you to a refund unless arranged prior to registration. Otherwise, your 100% credit will be honoured for up 2 years. Cash refunds will not be issued.

I read and understand the Facility Policy. *

Confirm

Primary Guardian *

Type full name to agree with terms.

I have read and agree to the terms and conditions *

Confirm

Total

ACE Development Program Registration Form – With Covid-19 Waiver

Please complete all required fields *

Name *

First

Last *

Last

Lives with: *

Primary Guardian

Address *

Address

City

State/Province

Zip/Postal

Country

Gender *

Male

Female

Other

Birthdate *

Height *

Weight *

T-Shirt Size *

Includes ACE Lacrosse T-Shirt

Years of Experience *

Are You A Goalie? *

Yes

Shoots *

Left

Right

Both

Minor Lacrosse Association *

School *

Medical Information

Medical Alert *

If none, note N/A

Family Doctor *

Name

Phone # (Include Area Code) *

Doctor’s Office

Health Questions

Have you ever been diagnosed with a heart condition and been told that your physical activity should be regulated by a doctor? *

Yes

When you do physical activity do you feel chest pains? *

Yes

Have you had chest pain in the last month when you were doing physical activity? *

Yes

Have you ever felt dizziness, lost consciousness or had poor balance? *

Yes

Do you have previous problems with bones or joints that would be worsened during physical activity? *

Yes

Are you taking any prescription medication for blood pressure or a heart condition? *

Yes

Are you aware of ANY OTHER REASON why you should not participate in physical activity? *

Yes

Do you have any life threatening anaphylactic allergies? *

Yes

If so, please give us more information in the drop-down section below.

Allergy Information

Optional: Fill out if necessary.

Allergy (1)

Medication & Dosage Instructions

Please include all essential details.

Allergy (2)

Medication & Dosage Instructions

Please include all essential details.

Medication & Dosage Instructions

Please include all essential details.

All Other Allergies

Standard Lacrosse New Brunswick Emergency Plan:
Epi-Pen is administered, 911 is notified, Parents and/or guardians are notified, Ambulance transports child to the hospital.

Any changes required for the Standard Emergency Plan?

Yes

Please provide details about alternate emergency plan.

Do you grant Lacrosse New Brunswick staff the right to administer your child’s Epi-Pen if need be?

Yes

Location of Epi-Pen:

Emergency Contact

Primary Legal Guardian

Name *

First

Last *

Last

Relationship *

Address *

Address

City

State/Province

Zip/Postal

Country

Mobile Phone *

Include Area Code

Other *

Email Address *

May we email you Lacrosse New Brunswick notices and program information? *

Yes

Secondary Contact

Optional: Fill out if necessary.

Name

First

Last

Relationship

Pick Up Authorization

Confirm

Address

City

State/Province

Zip/Postal

Country

Mobile Phone

Include Area Code

Other

Email Address

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT (THE “RELEASE”)

PLEASE READ CAREFULLY!

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION

With respect to participation in the Lacrosse Programs, I agree as follows:

I acknowledge that I am voluntarily participating in the Lacrosse Programs and that, as a result, employees, agents or representatives of the Club may interact with myself, my minor child, dependent, next of kin, and/or other members of my immediate or extended family.

I acknowledge that there is currently an ongoing global COVID-19 pandemic and that COVID-19 is a serious infectious disease that carries with it risk of serious personal or bodily injury including death. I acknowledge that participation in the Lacrosse Programs involves risks and dangers. I recognize that these risks may include (without limitation) illness, bodily or psychological damage and/or injury, including the risk that I, my child, dependent, next of kin or immediate or extended family may be exposed to COVID-19. I agree to assume all of these risks and all other risks incidental to participation in the Lacrosse Programs.

Accordingly, I, my heirs, executors, administrators, successors and assigns do hereby waive and release the Club and all of its affiliated, related and/or participating corporations, companies, entities and organizations, including, but not limited to LACROSSE NEW BRUNSWICK INC., and their agents, successors, servants, trustees, employees, officers, directors, assigns and independent contractors (collectively the “Released Parties”) from any and all liability for any loss, illness, bodily or psychological damage and/or injury, including the transmission of COVID-19, or expense that I may have as a result of participation in the Lacrosse Programs. I hereby waive as against the Released Parties all recourse, proceedings, demands, claims and causes of action of any kind whatsoever, whether in law or in equity, in respect of any and all loss, illness, bodily or psychological damage and/or injury, including the transmission of COVID-19, or expense which I may suffer arising out of, or in connection with, participation in the Lacrosse Programs, notwithstanding that such loss, illness, bodily or psychological damage, injury and/or expense may have been caused in whole or in part by the negligence, gross negligence or strict liability of the Released Parties or otherwise.

I also agree to indemnify, defend and hold harmless the Released Parties from and against any claims, demands, actions, causes of action, damage, loss, costs, liability or expense which may be made or brought against the Released Parties by me, my minor child, dependent or immediate or extended family member, as a result of the participation in the Lacrosse Programs, whether caused in whole or in part by the negligence, gross negligence or strict liability of the Released Parties or otherwise.

I agree to abide by all rules, including those related to cleaning and/or hygiene requirements to prevent the spread of COVID-19, of the Released Parties when participating in the Lacrosse Programs.

I agree that this release shall be governed by and interpreted in accordance with the laws of New Brunswick and Canada, as applicable. I also agree that this release is intended to be as broad and inclusive as is permitted by New Brunswick law. If any portion of this release is held invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect.

I AM FREELY AND VOLUNTARILY SIGNING BELOW AND ASSUMING ALL OF THE AFORESAID RISKS AND HAZARDS, AND, ACCORDINGLY, MY PARTICIPATION IN THE LACROSSE PROGRAMS SHALL BE ENTIRELY AT MY OWN RISK.

I VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.

Name of Participant (Full Name) *

I have read and agree to the terms and conditions

[If Participant is under 19 or incapable of providing legal consent]

Name of Primary Guardian (Full Name) *

Today’s Date *

I read, understand and agree to the terms of the Covid-19 Waiver *

Confirm

FACILITY SAFETY POLICY

For your Safety and to Protect our Facilities, Lacrosse New Brunswick Lacrosse Camps are SMOKE FREE on all premises!
Fighting, use of abusive language, being disrespectful to other campers, camp staff, or damaging facility property is unacceptable and may result in dismissal from the facility.
Drugs or alcohol in the facility or, on the grounds are strictly forbidden. Staff reserves the right to search bags for alcohol and drugs and to deny access to anyone who appears to be under the influence.
For health and safety reasons, no animals (except guide/aid animals) should be in the Facility.
Food or drink (except water in a closed container) should not be taken onto the floor at any time. Please clean up after yourself and dispose of waste properly.
Gum should be disposed of in the proper waste receptacles.
Photography or recording devices (including cell phones with camera and recording capability) are NOT permitted, except where authorized.
To protect yourself and our equipment please wear: athletic shoes with clean, rubber soles and cleats (no metal cleats) for the Field, and; appropriate workout wear; T-shirts, long sleeve shirts, shorts of appropriate length, athletic pants/leggings. Please, do not wear: string/ cut off/mesh tank tops, jeans, street clothing, and anything displaying inappropriate slogans or offensive text or images; cleated shoes inside the building or; perfume, cologne, body spray, or hairspray.
Please do not bring your gym bags and valuables outside of locker room areas. Lacrosse New Brunswick is not responsible for lost or stolen items; please leave valuables at home. Lost and found articles are donated to a local charity if not claimed within 7 days. Personal items (i.e. razors, hairbrushes) are disposed of for hygienic reasons.
We recommend that you stay for the entire day in order to benefit from a proper cool-down.
Only those with appropriate supervision, attire and ID, will be permitted access to the workout and training areas.
It is the campers responsibility to wear his/her helmet at all times during drills, practices, scrimmages and games.
Avoid injury when lifting weights: Before starting, warm-up properly, secure collars and check the equipment. Use proper body position and breathing technique. Use of spotters is recommended for all lifting. Return free weights and dumbbells to the appropriate racks when finished.
Unsupervised/unauthorized use of the gym is not permitted.
Spectators and pets must remain outside the fenced area. No cigarettes, food, gum, sunflower seeds or beverages on the field.

THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS. PLEASE READ IT CAREFULLY!

THE WAIVER

b) that Lacrosse New Brunswick are not liable or responsible for any damage to, loss or theft of your property;

PHOTO/VIDEO RELEASE

Cancellation/Refund Policy

I read and understand the Facility Policy. *

Confirm

Primary Guardian *

Type full name to agree with terms.

I have read and agree to the terms and conditions *

Confirm

Total

ACE Development Program Registration

Please complete all required fields *

Medical Information

Health Questions

Allergy Information

Emergency Contact

Primary Legal Guardian

Secondary Contact

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT (THE “RELEASE”)

PLEASE READ CAREFULLY! BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION

FACILITY SAFETY POLICY

Please complete all required fields *

Medical Information

Health Questions

Allergy Information

Emergency Contact

Primary Legal Guardian

Secondary Contact

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT (THE “RELEASE”)

PLEASE READ CAREFULLY! BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION

FACILITY SAFETY POLICY

PLEASE READ CAREFULLY!

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION

PLEASE READ CAREFULLY!

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION