Ottawa Player Registration – KC Smoke Men’s League CONTACT INFOName* First Last Date of Birth (Must Be 18+ as of 1/1/2024)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*PLAYER INFOPosition*ForwardDefenseGoalieFOGODominant Hand*RightLeftJersey Size*SMLXLXXLLIABILITY WAIVER & PAYMENTHold Harmless Consent* I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I HAVE READ, FULLY UNDERSTAND, AND VOLUNTARILY AGREE TO THE TERMS OF THIS AGREEMENT WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.I know that participation in the Box Lacrosse League (BLL) is a potentially hazardous activity and I agree that my participation is entirely voluntary. I know I should not enter this activity unless I am medically able to participate, and the signature below attests that I am medically fit to participate. I know that the hazards of the game’s activities include but are not limited to: rigorous exercise and exertion, falling, collision with other participants, collision with fixed objects, and being struck by game objects (i.e. balls, sticks, etc.). I further state that I know that injuries can range from minor to serious, including loss of sight, paralysis, and death. That in consideration of my participation in the BLL activities, games, tournaments, and any other associated events, I agree, on behalf of myself, my assigns, my personal representative, beneficiaries, executors, and heirs, to waive, release and hold harmless the Box Lacrosse League and its managers, officers, staff, officials, agents, and any owner or operator of any facilities operated, leased, or used by BLL and/or any individual or entity for whom BLL may be held vicariously liable (the “BLL Released Parties”) of and from any and all liability, damage, cost, or claim of any nature whatsoever arising out of or related to my participation, including but not limited to those arising from the BLL Released Parties’ own acts, omissions, negligence or fault. That in consideration of my participation in the BLL activities, games, tournaments, and any other associated events, I agree, on behalf of myself, my assigns, my personal representative, beneficiaries, executors, and heirs, to waive, release and hold harmless all Box Lacrosse League franchises, their respective officers, managers, agents, staff, players, coaches, and any owner or operator of any facilities operated, leased, or used by any BLL team and/or any individual or entity for whom BLL may be held vicariously liable (the “BLL Franchise Released Parties”) of and from any and all liability, damage, cost, or claim of any nature whatsoever arising out of or related to my participation, including but not limited to those arising from the BLL Franchise Released Parties’ own acts, omissions, negligence or fault. I understand that the Box Lacrosse League will provide personal accident insurance coverage, but will not provide primary health insurance. I understand that I am required to hold my own personal primary health insurance coverage throughout my participation in the Box Lacrosse League and BLL sanctioned activities. I irrevocably grant the BLL and the BLL’s assigns, licensees, and successors the right to use my name, image, and likeness in all forms and media including composite or modified representations for all purposes, including advertising, trade, or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images. I release the BLL and the BLL’s assigns, licensees, and successors from any claims that may arise regarding the use of my image and likeness, including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright. The BLL is permitted, although not obligated, to include my name as a credit in connection with the image. With my participation, I agree to follow all BLL Regulations and Policies including but not limited to sexual abuse, sexual harassment, drugs and alcohol, social media, and concussion protocol. This agreement and the scope of the release, waiver, and covenant not to sue herein shall be governed by the laws of the State of Missouri, without respect to its conflict of laws principles. Any claim or dispute between the undersigned Participant, and BLL Released Parties and/or the BLL Franchise Released Parties that arises in whole or in part from the BLL events and/or activities shall be decided exclusively by a court of competent jurisdiction located in Kansas City, Jackson County, Missouri.CAPTCHA