BELTWAY LACROSSE (BLX)

MINOR PARTICIPANT RELEASE, WAIVER OF LIABILITY,

ASSUMPTION OF RISK & INDEMNIFICATION AGREEMENT
(Virginia — Parent/Guardian Consent Required for Participants Under 18)

PLEASE READ CAREFULLY. THIS IS A LEGALLY BINDING DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS AND THE RIGHTS OF YOUR CHILD.

In consideration of the minor child identified below (“Minor Participant”) being permitted to participate in any league, game, tournament, clinic, camp, training session, open play, or related activity (collectively, the “Program”) operated, organized, or sponsored by Beltway Lacrosse (“BLX”), the undersigned parent or legal guardian (“Parent/Guardian”) agrees as follows:

1. Parent/Guardian Consent

I certify that I am the parent or legal guardian of the Minor Participant and have the legal authority to sign this Agreement on the child’s behalf. I give permission for my child to participate in the Program.

2. Acknowledgment of Risks

I understand that lacrosse is a contact sport involving sticks, hard balls, physical contact, rapid movement, and physical exertion. Participation involves inherent risks, including but not limited to:

Concussions and head injuries
Fractures, sprains, strains, and ligament injuries
Dental and facial injuries
Heat-related illness or dehydration
Permanent disability, paralysis, or death

These risks may result from:

The actions of my child or other participants
Coaching decisions or instruction
Playing surface or facility conditions
Equipment failure
Weather conditions
The negligence of others

I acknowledge that not all risks can be eliminated.

3. Assumption of Risk

On behalf of my child and myself, I knowingly and voluntarily assume all risks associated with participation in the Program, whether known or unknown, foreseeable or unforeseeable, to the fullest extent permitted by Virginia law.

4. Health Certification

I certify that my child is physically able to participate and has no medical condition that would make participation unsafe, or that such condition has been disclosed to BLX.

I understand that BLX does not provide medical or health insurance for participants.

5. Compliance With Rules

I agree that my child will follow all rules, policies, and safety instructions established by BLX, coaches, officials, staff, and facility operators. I understand that failure to comply may result in removal from participation without refund.

6. Release and Waiver of Liability

To the fullest extent permitted by the laws of the Commonwealth of Virginia, I, on behalf of myself and the Minor Participant, hereby release, waive, discharge, and hold harmless:

Beltway Lacrosse (BLX) and its owners, directors, officers, employees, contractors, agents, volunteers, coaches, officials, sponsors, affiliates, other participants, and the owners or operators of facilities used for the Program (collectively, the “Releasees”)

from any and all claims, demands, causes of action, damages, losses, or expenses arising out of or related to the Minor Participant’s participation in the Program, including claims arising from the ordinary negligence of the Releasees, to the fullest extent permitted by Virginia law.

This release does not apply to acts of gross negligence or willful misconduct to the extent prohibited by law.

7. Indemnification

I agree to indemnify, defend, and hold harmless the Releasees from any claims, damages, liabilities, costs, or attorneys’ fees arising from:

My child’s participation in the Program
My child’s actions or omissions
Any claim brought on behalf of my child

to the fullest extent permitted by Virginia law.

8. Medical Authorization

I authorize BLX staff, volunteers, or agents to obtain emergency medical treatment for my child if I cannot be reached. I agree to be responsible for all medical expenses incurred.

Emergency Contact (if different from Parent/Guardian):

Name: ___________________________
Phone: ___________________________

9. Communicable Disease Risk

I understand that participation may expose my child to communicable diseases, including COVID-19, influenza, or other illnesses, and I voluntarily assume all risks associated with such exposure.

10. Image and Likeness Release

I grant BLX permission to use my child’s name, image, likeness, voice, and appearance in photographs or video for promotional, marketing, or educational purposes without compensation.

11. Governing Law

This Agreement shall be governed by the laws of the Commonwealth of Virginia, and any legal action shall be brought in Virginia.

12. Severability

If any portion of this Agreement is held invalid, the remaining provisions shall remain in full force and effect.

13. Electronic Signature

I agree that my electronic signature or selection of “I Accept” constitutes a legally binding signature equivalent to a handwritten signature.

PARENT/GUARDIAN ACKNOWLEDGMENT

I HAVE READ THIS AGREEMENT CAREFULLY.
I UNDERSTAND THAT I AM ASSUMING RISKS AND GIVING UP CERTAIN LEGAL RIGHTS ON BEHALF OF MYSELF AND MY CHILD.
I SIGN THIS AGREEMENT VOLUNTARILY.

Beltway Lacrosse

DMVI SUMMER LEAGUE 2026

High School Girls