2018 Fall Tournament Team Registration
Last Name
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1st Name
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Date of Birth
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Gender
School
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Grade
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Lax Position
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Street Address
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City
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State
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Zip Code
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Email
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Phone Number
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US Lacrosse #
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Health Insurance Company
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Health Insurance Policy #'s
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Medical Conditions
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Parent Name
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Emergency Contact
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Emergency Contact #
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In consideration of my child’s participation in the 2018 Fall Tournament Team and related events and activities, I agree to the following: Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death that my child may suffer, associated with their participation in a lacrosse event and related sports conditioning activities. I agree on behalf of myself, my heirs and personal representatives, that CityLax, Inc., along with participating coaches, officials, referees, volunteers, employees, agents, sponsors, including but not limited to the facility and venue used for the event, and all of its affiliates and subsidiaries, and the officers and directors of these organizations, shall not be liable for any such injury, or other loss or damage that my child may suffer, or for death, occurring as a result of my participation in the events.
Medical Attention: I hereby give my consent to CityLax, Inc. providing, through a medical staff of either’s choice, medical/athletic training attention, transportation and emergency medical services as warranted in the course of my child’s participation in the Events.
Readiness to Compete: My child will only participate in the Events if I believe that they are physically and psychologically prepared to participate. If my child does participate, they agree to conform to the Events’ Code of Conduct.
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