Player Application – Watchdog Media Inc

2024 Select Lacrosse Registration

Player Name *

First

Last

Parent / Guardian Name *

First

Last

Parent / Guardian Email *

Parent Cell Phone *

Player US Lacrosse # *

Player Grade (as of Jan 1, 2022) *

Player Birthdate *

PLEASE READ AND ACKNOWLEDGE ALL OF THE FOLLOWING REQUIRED WAIVERS

Do you certify that you understand the physical requirements to play lacrosse and that your child is healty enough to participate? *

RELEASE OF LIABILITY / INDEMNIFICATION WAIVER IN CONSIDERATION OF my child/ward named on this application, being allowed to participate in any way in the WATCHDOG YOUTH SELECT SPORTS / WATCHDOG MEDIA INC. youth lacrosse related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, 2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS WATCHDOG YOUTH SELECT SPORTS / WATCHDOG MEDIA INC; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. 5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement. I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. *

I AGREE to the terms of this REALEASE OF LIABILITY / INDEMNIFICATION STATEMENT

Parent Concussion Information & Acknowledgement Form This acknowledgement form has information to help protect your children or teens from concussion or other serious brain injury. Use this information at your children’s or teens’ games and practices to learn how to spot a concussion and what to do if a concussion occurs. WHAT IS A CONCUSSION? A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells. WHAT IS A CONCUSSION? A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells. HOW CAN I SPOT A POSSIBLE CONCUSSION? Children and teens who show or report one or more of the signs and symptoms listed below—or simply say they just “don’t feel right” after a bump, blow, or jolt to the head or body—may have a concussion or other serious brain injury. SIGNS OBSERVED BY PARENTS/COACHES: - Appears dazed or stunned. - Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent. - Moves clumsily. - Answers questions slowly. - Loses consciousness (even briefly). - Shows mood, behavior, or personality changes. - Can’t recall events prior to or after a hit or fall. - Symptoms Reported by Children and Teens - Headache or “pressure” in head. - Nausea or vomiting. - Balance problems or dizziness, or double or blurry vision. - Bothered by light or noise. - Feeling sluggish, hazy, foggy, or groggy. - Confusion, or concentration or memory problems. - Just not “feeling right,” or “feeling down.” Talk with your children and teens about concussion. Tell them to report their concussion symptoms to you and their coach right away. Some children and teens think concussions aren’t serious or worry that if they report a concussion they will lose their position on the team or look weak. Be sure to remind them that it’s better to miss one game than the whole season. Concussions a ect each child and teen differently. While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children’s or teens’ health care provider if their concussion symptoms do not go away or if they get worse after they return to their regular activities. WHAT ARE SOME MORE SERIOUS DANGER SIGNS TO LOOK OUT FOR? In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or take your child or teen to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs: - One pupil larger than the other. - Drowsiness or inability to wake up. - A headache that gets worse and does not go away. - Slurred speech, weakness, numbness, or decreased coordination. - Repeated vomiting or nausea, convulsions or seizures (shaking or twitching). - Unusual behavior, increased confusion, restlessness, or agitation. - Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously. Children and teens who continue to play while having concussion symptoms or who return to play too soon—while the brain is still healing— have a greater chance of getting another concussion. A repeat concussion that occurs while the brain is still healing from the rst injury can be very serious and can a ect a child or teen for a lifetime. It can even be fatal. What Should I Do If My Child or Teen Has a Possible Concussion? As a parent, if you think your child or teen may have a concussion, you should: - Remove your child or teen from play. - Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a health care provider and only return to play with permission from a health care provider who is experienced in evaluating for concussion. - Ask your child’s or teen’s health care provider for written instructions on helping your child or teen return to school. You can give the instructions to your child’s or teen’s school nurse and teacher(s) and return-to-play instructions to the coach and/or athletic trainer. Do not try to judge the severity of the injury yourself. Only a health care provider should assess a child or teen for a possible concussion. Concussion signs and symptoms often show up soon after the injury. But you may not know how serious the concussion is at rst, and some symptoms may not show up for hours or days. The brain needs time to heal after a concussion. A child’s or teen’s return to school and sports should be a gradual process that is carefully managed and monitored by a health care provider. I CERTIFTY THAT I HAVE DISCUSSED THE RISKS OF CONCUSSION AND OTHER SERIOUS BRAIN INJURY WITH MY CHILD OR TEEN AND ACKNOWLEDGE IT BELOW. *

I have read this fact sheet on concussion with my child or teen and talked about what to do if they have a concussion or other serious brain injury.

Player/Parent Code of Conduct - Watchdog Media Inc Youth Select Sports (WDMYSS) requires that each Player/Parent comply with and uphold the Player/Parent Code of Conduct. This Code of Conduct shall apply to all activities, interactions, and representation of WDMYSS including, but not limited to, practices, games, tournaments, meetings, and team events. In the event a participant's conduct violates this Code of Conduct, the WDMYSS will take disciplinary action up to and including suspension from WDMYSS and its sponsored programs. This code of conduct does not supersede or otherwise modify any rules or requirements of Sumner-Bonney School District, for which Player/Parents may also be obligated to. Player/Parents will compete and watch events with heart, honor and hustle. Honoring the traditions of the game and respect of the ancestors of the sport. Player/Parents will have fun, be passionate, and adhere to the spirit of the game both on and off the field. WDMYSS encourages good sportsmanship and fair play. WDMYSS will not tolerate any Player/Parent's violation of the Player/Parent Code of Conduct. WDMYSS has a ZERO TOLERANCE policy in regard to targeted hits, retaliation, unsportsmanlike conduct and bullying. All Player/Parents will abide by the following: Refrain from use of abusive or vulgar language especially that aimed at Player/Parents, coaches, fans, referees or other officials. Always demonstrate good sportsmanship. Player/Parents will conduct themselves in a sportsmanlike and respective manner towards Player/Parents, coaches, fans, or any referees or other official. It is imperative that all WDMYSS Player/Parents conduct themselves in a proper manner. Play by the rules, upholding the honor and dignity of the game of lacrosse, Honor the Game. Concentrate on playing lacrosse and on affecting the outcome of the game with your best effort. Will accept adverse decisions without argument or complaint about a referee's call or decision. Will maintain control of your temper; will NOT retaliate when you feel you have been wronged; will NOT taunt. Work to achieve the goals of being as competitive as possible, developing teamwork, improving your skills and having high character and integrity. Be on time for practices and games and commit to giving your best at all times. This Code of Conduct must be complied with by all WDMYSS Player/Parents who wish to participate in any WDMYSS event. WDMYSS membership or participation in any sponsored event indicates that the person has read and agrees to abide by this Code of Conduct and knows that the consequences of violating this Code of Conduct may include suspension from any or all WDMYSS sponsored events and activities. I have read and agree to abide by the above requirements set for WDMYSS Player/Parents. By signing below, I acknowledge my understanding that violation of any of the items in the Player/Parents Code of Conduct will result in review by the WDMYSS, and possible punishment, up to and including suspension from WDMYSS. *

I have read this fact sheet and will certify that my child, spouse and other family members will honor and comply with this Code of Conduct

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