Brentwood

BRENTWOOD RECREATION DEPARTMENT

Youth Lacrosse

Sports/Program Waiver

As a participant or parent/guardian of a child in the below listed Brentwood Recreation Department sport/activity, I am aware participation may involve risk of injury. I agree to assume all risks and hazards incidental to the program(s), including transportation to and from the site of said program. I hereby waive, absolve, indemnify and agree to hold harmless the Town of Brentwood, the Brentwood Recreation Department, The Brentwood Recreation Commission, supervisors, instructors and participants from all claims, demands of chance on account of any and all injuries to persons or property that may result by virtue of participation in said activities. I give my permission for my child to be treated by qualified medical personnel in the event that the parent/guardian named above cannot be reached. Participants may be photographed for Town of Brentwood promotions. Registrations for programs will be accepted on a first come, first serve basis. Please call the Recreation office if you have any questions.


Coronavirus (Covid-19) Assumption of Risk and Waiver of Liability

The novel coronavirus, Covid-19, has been declared a worldwide pandemic by the World Health Organization. Covid-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. The town of Brentwood Parks & Recreation has created new protocols and put in place preventative measures to reduce the spread of Covid-19: however, Brentwood Recreation cannot guarantee that you or your child(ren) will not become infected with Covid-19. Further, attending any program may increase you or your child(ren) risk of contracting Covid-19.

By signing this agreement, I acknowledge the contagious nature of Covid-19 and voluntarily assume the risk that my child(ren) and I maybe exposed to, or infected by Covid-19 by attending a Brentwood Recreation program, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by Covid-19 at any Brentwood Recreation program may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Brentwood Recreation employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any Brentwood Recreation program. On my behalf, and on behalf of my child(ren), I herby release, covenant not to sue, discharge, and hold harmless Town of Brentwood, Parks and Recreation and, its employees, agents, and representatives, of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence, of Brentwood Recreation employees, agents, and representatives, whether a Covid-19 infection occurs before, during, or after participation in any Brentwood Recreation program.

** Please note:  Fields denoted with a *  are required fields and must be filled in to submit this form.

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Participant Information
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Emergency Contact Information
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Please initial below to verify information and agree to terms. If participant is under 18 years of age, parent/guardian must initial below and therby agree to the conditions at the top of this page.
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