Registration
NOTE: in order to complete and submit this registration, you will be required to upload a copy of your child's most recent physical in the question near the end. Please have this information on hand before filling this out.
Email address *
Player Information
Player Name *
First & Last
Your answer
Age on June 19, 2019 *
Current Grade *
This is the grade the player is in NOW, not what grade they will be entering in the fall.
School Student Attends *
Your answer
Select Your Program *
Parent Information
Parent Name *
First & Last
Your answer
Email Contact - most frequently checked *
This is where we will send all schedules, announcements, and will be our primary way of communicating.
Your answer
Parent Cell *
(###) ###-####
Your answer
Street Name & Number *
Your answer
Apt. or Unit Number if applicable
Your answer
Town *
State *
Zip Code *
Your answer
Emergency Contact
Other than Parent
Name *
First & Last
Your answer
Cell *
(###) ###-###
Your answer
Email Contact *
Your answer
Insurance Information
Insurance Company Name *
Your answer
Insurance Policy # *
Your answer
Family Physician Name *
Your answer
Physician Phone # *
(###) ###-####
Your answer
Waiver
Please read the following and check below: I/we give my consent to the below named player to participate in the NLC (Needham Lacrosse Clinic). I/we assume all risks and hazards incidental to the conduct of the activities and do further release, absolve, indemnify, and hold harmless the organizers, coaches, refs, and supervisors of the NLC. In case of injury to my/our participant, I/we waive any claims against those named above and anyone appointed by them. I understand that the activity I am participating in is a physical, high-risk sport and the I/they are participating in this club at my/their own risk with full knowledge of the dangers associated with participation. I have read the above paragraph and understand it fully. The release is checked off as my own free act and deed.
*
Required
Return to Registration Page to Complete Payment *
Required
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