Denver, CO – June 25th 2022 Combine Registration CONTACT INFOName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PLAYER INFOPosition*FowardFOGODefenseGoalieLIABILITY WAIVER & PAYMENTHold Harmless Consent* I agree to the policy.I know that participation in the Great Plains Box Lacrosse League - Men’s League 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 GPBLL 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 Great Plains Box Lacrosse League and its managers, officers, staff, officials, agents, and any owner or operator of any facilities operated, leased, or used by GPBLL and/or any individual or entity for whom GPBLL may be held vicariously liable (the “GPBLL 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 GPBLL Released Parties’ own acts, omissions, negligence or fault. That in consideration of my participation in the GPBLL 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 Great Plains Box Lacrosse League teams, their respective officers, managers, agents, staff, players, coaches, and any owner or operator of any facilities operated, leased, or used by any GPBLL team and/or any individual or entity for whom GPBLL may be held vicariously liable (the “GPBLL Team 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 GPBLL Team Released Parties’ own acts, omissions, negligence or fault. I understand that the Great Plains Box Lacrosse League will not provide any Accident or Medical Insurance. I hereby consent to any publicity, including the use of my name and likeness, in connection with my participation in these activities under the Great Plains Box Lacrosse League. 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 GPBLL Released Parties and/or the GPBLL Team Released Parties that arises in whole or in part from the GPBLL events and/or activities shall be decided exclusively by a court of competent jurisdiction located in Kansas City, Jackson County, Missouri. I have read and understand the terms of this Release & Covenant and agree to all terms and conditions. I further understand that the terms of this agreement are legally binding, and by clicking the checkbox I certify that I am agreeing to these terms, after having carefully read the same, of my own free will. I am of adult lawful age (18+) and legally competent to agree to this waiver and release terms and I have agreed to these terms of my own free act.CAPTCHA