2021 Winter Lacrosse Registration
Saturdays January 23, 30, February 6, 13, 20, 27
Outdoors at Beck Middle School
950 Cropwell Road, Cherry Hill, NJ

Boys Grades 2-5 10:00-11:00am
Boys Grades 6-8 11:15-12:15pm
Girls Grades 2-5 12:30-1:30pm
Girls Grades 6-8 1:45-2:45pm
Email address *
Parent (First and Last Name) *
Athlete (First and Last Name) *
Athlete Age *
Athlete 2020-2021 Grade *
Gender *
US Lacrosse number (Each participant must be an active member of US Lacrosse) *
Did you pay the registration fee to Paypal @chelax? *
My son/daughter received a Red/White reversible during the 2020 Fall League. *
Reversible Pinny Size *
Student School *
Town *
Years playing Lacrosse *
Position Played *
Emergency Contact #1 Cell *
Emergency Contact #2 Cell *
RELEASE OF LIABILITY FOR MINOR PARTICIPANTS: In consideration of my child/ward being allowed to participate in any way in Cherry Hill Varsity Lacrosse related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, 1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, 2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Cherry Hill Varsity Lacrosse; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. 5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement. I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. *
I will check my child's temperature each morning before leaving our house. If my child has a temperature above 100.3 F I will keep my child home and contact the coaching staff. *
If my child or a family member has any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt "feverish," or had a temperature that is elevated for you or 100.4F or greater I will keep my child home and contact the coaching staff. *
If my child or a family member has any of the following: Fever or chills• Cough• Shortness of breath or difficulty breathing• Fatigue• Atypical muscle pain or body aches• Headache• New loss of taste or smell• Sore Throat• Congestion or runny nose• Nausea or vomiting• Diarrhea * I will keep my child home and contact the coaching staff. *
If my child a family member has been exposed to, or come into contact with, anyone you know: (a) who has COVID-19, (b) who had symptoms consistent with COVID-19, or (c) who was exposed to someone with COVID-19 I will keep my child home and contact the coaching staff. *
If my child visits a high risk country or state or has extended close contact with someone who has within the last 14 days I will keep my child home and contact the coaching staff. *
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