ISC Boys LAX Clinic Registration
To register for the ISC Boys LAX Clinic please fill out the information in the fields below. Be sure to fill in all required fields. Registration will hold a place for your child as space is limited. You must select the PayPal option to complete this registration. Please indicate order of desired classes in notes below.
Child's Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
Your answer
Current Grade *
Clinic Choice *
Choose your session
Address *
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City / State / Zip *
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Email Address *
Your answer
Home Phone *
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Cell Phone *
Your answer
Being allowed access to the facilities of ISC of Mt. Laurel LLC, and/or International Sports Centre, it is understood and agreed: 1. ACKNOWLEDGE, agree and state that I understand that nature of ISC of Mt. Laurel LLC, and/or International Sports Centre activities and that I am qualified, in good health, and in proper condition to participate in such activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the activity. 2. Soccer, lacrosse, field hockey, volleyball, basketball, roller hockey, deck hockey, baseball, flag football, futsal wrestling and any/all other sports conducted by ISC of Mt. Laurel, LLC, and/or International Sports Centre, are games involving physical exertion, speed, and physical contact and that participation in these sports potentially could result in serious injury or death arising out of field/surface conditions, player conduct, referee conduct, equipment, and other factors, including random chance. I and / or my minor child are fully aware of these risks. 3. ISC of Mt. Laurel LLC, and/or International Sports Centre, it’s owners, operators, employees, and agents are hereby released from any and all claims for injuries or damages which may occur while player is on the premises of ISC of Mt. Laurel LLC, and/or International Sports Centre, or engaged in any activity in connection therewith, whether such injuries or damages are foreseen or unforeseen. It is further understood and agreed that the undersigned agrees to defend, hold harmless, and indemnify ISC of Mt. Laurel LLC, and/or International Sports Centre, from any claim by player, the undersigned, player’s family, estate, heirs, or assigns. 4. I also represent and warrant that I carry my own health and liability insurance coverage in amounts sufficient to provide adequate compensation for any losses or expenses incurred due to injury while I am (or my minor child is) a participant at the ISC of Mt. Laurel LLC, and/or International Sports Centre. 5. I am fully aware of the rules and regulations of ISC of Mt. Laurel LLC, and/or International Sports Centre, and agree to be bound thereby. 6. I further state that I am of lawful age and legally competent to sign this affirmation, release, hold harmless, and indemnity agreement; that I understand the terms herein are contractual and not a mere recital; and that I have signed this document after reading it and as my own free act. Initial if you agree to terms: *
Your answer
In case my child becomes ill or injured at ISC of Mt. Laurel LLC, and/or International Sports Centre and I cannot be contacted, please call (list name and number) *
Your answer
I authorize my child’s coach / rep to obtain emergency medical treatment for my child in my absence. Initial please: *
Your answer
Please list any medical problems, including allergies: *
Your answer
Any physical limitations: *
Your answer
Family Doctor (name and phone) *
Your answer
Parents must assume responsibility for transportation to home or hospital. In case of EXTREME emergency, I wish my child to be taken to the hospital listed below:: *
Your answer
I have read and reviewed the ISC of Mt. Laurel LLC, and/or International Sports Centre, rules and regulations with my child. Electronic Signature below: *
Your answer
Date this agreement is signed *
Your answer
Now that you have completed your registration go back to the Paypal link to make your payment for your registration. If you have any questions, please do not hesitate to contact Lynne Prairie Coates at 856-273-2828 or by email at lynne@intsports.com. Use box below for any notes.
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