Spring Lake Lacrosse Organization 2016 Registration Form
Player # 1 Registration
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Team Registration *
What team are you registering for?
Player Last Name *
Player First Name *
Date of Birth *
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Player Cell Phone
example: 616-123-4567
Player e-mail
School *
Grade *
Position Played *
Parent Guardian Full Name *
Home Phone
Parent/Guardian #1 Cell Phone
example: 616-123-4567
Parent/Guardian #1 e-mail *
Parent/Guardian #2 Full Name *
Parent/Guardian #2 Cell Phone
example: 616-123-4567
Parent/Guardian #2 e-mail *
Address *
City *
Zip *
Emergency Contact Full Name *
Emergency Contact Phone *
Photo Release *
I understand that photography and/or video of participants may be procured during activities and used in promotional materials, including publication on the Spring Lake Lacrosse Organization website.  I consent to the use of images or likenesses of my child/ward for promotional purposes by the Spring Lake Lacrosse Organization. Please initial below.
Waiver and Release *
My child/ward is in good health and has my full permission to participate in the Spring Lake Lacrosse program.  My child/ward has no existing or prior sickness, illness, disease or bodily injury that is contradictory to participation.  I fully understand that lacrosse is a contact sport and that physical injury may occur during the course of participation.  I certify that my child/ward has my permission and consent to participate in the Spring Lake Lacrosse Organization program during the coming season.  I fully release and hold harmless the Spring Lake Lacrosse Organization, its teams, coaches, field directors, managers, referees, sponsors, Board of Directors, officers, Spring Lake Public Schools or any others connected to the club for injuries sustained by my child in practice, game play or while being transported to or from Spring Lake Lacrosse Organization activities.  Furthermore, I agree that I will not hold any doctor, nurse, team, coach or league official responsible for the consequences of any voluntary medical or first-aid treatment administered to my child as a result of any injury sustained in connection with Spring Lake Lacrosse Organization activities.  Please initial below.
Known Medical Conditions *
Current Medications *
Primary Care Physician *
Primary Care Phone *
Insurance Company *
Insurance Policy and Group # *
Local Hospital Preference *
Electronic Signature of Parent/Guardian *
Date Registration Form Completed *
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Do you need to register another player? *
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