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Peters Township Boys Youth Lacrosse Association


Registration to Play PTBYLA Lacrosse

The following is a republication of the agreement that you, as a parent, have agreed to when registering your
child to play lacrosse (via the use of an electronic signature).  This is reprinted here for reference only.

By registering your child, you agree to the following. You must scroll down to the bottom and select the "I / We Accept the
above" check box in order to complete registration. By completing this player registration, you affirm that you are the
parent and / or legal guardian for the player being registered. You agree that electronic acceptance shall be binding just as
an original signature.)
I / We give permission for my child to participate in Peters Township Boys Youth Lacrosse sponsored by the Peters
Township Boys Youth Lacrosse Association (PTBYLA). Participation will be in accordance with the PTBYLA By-Laws and in
full accordance with all insurance requirements and conditions set forth by PTBYLA. I shall not permit my child to
participate, represent or play in any PTBYLA contest, scrimmage, tournament, practice or other competition until my child
has been examined by a licensed physician of medicine or osteopathy before commencement of the Lacrosse season and
my child has been declared physically able to participate in the sport of Lacrosse by said physician.  I / We also
acknowledge that PTBYLA has strongly recommended that my child have completed concussion testing within the prior 6
months and that I / we ensure that an updated concussion baseline is on file with my child's physician of medicine. 
I / We acknowledge that injuries including death might occur by participating in Boys Lacrosse since injuries including
death are inherent to any physical activity or sport. I / We understand that PTBYLA in conjunction with U.S. Lacrosse, Inc.
(US Lacrosse) is requiring General Liability-Excess Liability and Accident Medical Insurance for all participants in Boys
Lacrosse while participating on the field. This coverage is automatically provided by US Lacrosse by maintaining a valid up
to-date US Lacrosse membership for your child. In addition to this US Lacrosse provided coverage, I / we shall purchase
and maintain required continuous and uninterrupted medical insurance for my child during the period of participation in
lacrosse activities and shall retain complete responsibility for medical care and related expenses that may not be covered
by the above referenced US Lacrosse insurance. PTBYLA, and its agents, are authorized to contact and communicate with
our Medical Insurance provider for the sole purpose of verifying medical coverage provided for my participant child. I / We
agree that failure to provide continuous and uninterrupted medical insurance, and proof of said coverage upon reasonable
request, will result in my child being removed from participation in all PTBYLA activities and events. I / We shall promptly
notify PTBYLA in writing (at [email protected]) of any changes to my / our child's medical coverage or information
that may occur during the season. 
I / We acknowledge that injuries including death might occur in the course of private or public transportation of my / our
child involving Boys Lacrosse warm-ups, practices, scrimmages, games, tournaments and any other activities as related to
Boys Lacrosse. I / We also recognize that that injuries can be dramatically reduced, minimized or eliminated when lacrosse
participants are properly protected by wearing approved and recommended equipment. I / We agree that our child shall
not participate in lacrosse warm-ups, practice, scrimmage, games, tournaments and any other lacrosse activities unless
wearing a properly fitted National Operating Committee on Standards for Athletic Equipment (NOCSAE) approved
protective helmet in addition to the following unaltered protective equipment: shoulder pads, rib pads, gloves, arm pads,
mouthpiece and a protective athletic cup. 
I / We, for myself / ourselves and on behalf of my / our heirs, assigns, personal representatives and next of kin, hereby
release, agree to indemnify and hold harmless the Peters Township School District, the Peters Township Parks and
Recreation Board, the Peters Township Boys Youth Lacrosse Association, Coaches and instructors, members, sponsoring
agencies, sponsors, advertisers, and if applicable, owners or lessors of premises used to conduct an event and any agency
acting on behalf of PTBYLA from any expense that may be incurred in connection with injury to, including death of, my
child resulting from the participation in the sport of lacrosse or resulting from the transportation, either private or public as
related to a PTBYLA event or activity. 
In the event of injury, accident, or sickness, I / we authorize PTBYLA to seek treatment for my / our child by a licensed
physician and/or hospital. Medical care and / or treatment may be given under whatever condition is necessary to preserve
life, limb or well being of my / our child.
I / we give permission to PTBYLA and/or parties designated by PTBYLA to photograph my child and use / publish such
photographs on the PTBYLA website and in all forms of media for any and all promotional purposes related to youth
lacrosse; including advertising, display, audiovisual, exhibition or editorial use. I / we understand that there will be no
financial compensation to me for my or my child's time or expenses for this consent to photograph and I / we release
PTBYLA from any and all claims. 
Intending to be legally bound, I / we do hereby release, absolve and discharge Peters Township School District, the Peters
Township Parks and Recreation Board, the PTBYLA, its Executive Board members, coaches, employees, members and any
agent acting on behalf of PTBYLA from any liability to, or claims for damages related to, my child resulting from any cause
whatsoever, either unintentional or otherwise, in connection with participation in Peters Township Boys Youth Lacrosse
activities or events. I / We have read this Consent to Participate / Acknowledgement of Risk / Waiver & Release of Liability
/ Consent to Medical Treatment agreement(s) and have had an opportunity to consult legal counsel on the terms, fully
understand its terms, understand that I/ we have given up substantial rights by accepting it, and freely and voluntarily
without inducement agree to its terms by clicking on the "I / We Accept the above" check box below. I / We agree that
electronic acceptance shall be binding just as an original signature. 
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