North Carroll Boys Lacrosse - Clinics
Sign Up Sheet For 2021 Clinics
First Name *
Last Name *
Email *
Dates Attending
Current Grade *
Years of Experience *
NOTICES - Any activity involving motion or physical orientation and response involves a personal risk of injury, over-exertion or stress. The undersigned acknowledges that the North Carroll Recreation Council does not provide any registrant medical or hospitalization insurance whatsoever, and hereby waives any and all claims against the Recreation Council and the Bureau of Recreation and Parks or any other person affiliated with the Recreation Council program for injuries sustained while watching or playing games, traveling to and from games, or participation in any leisure time activity. I understand that, before my child may participate in any full contact activity, he/she must receive a Doctor's physical exam. I understand it's my responsibility to notify the head coach or program coordinator if there is any reason why my child should not participate in full contact activity. I understand that the participant is subject to the Council rules of conduct. Accessibility Notice: The Americans with Disabilities Act applies to the Carroll County Government and its programs, services, activities and facilities. If you have questions, suggestions or complaints, please contact Jolene Sullivan, the Carroll County Government Americans with Disabilities Coordinator, at 410-848-9707, 410-876-5253, 410-875-0094, and TT No. 410-848-5355. The mailing address is 225 North Center Street, Westminster, MD 21157. *
CONCUSSION NOTICE - In compliance with Maryland HB 858 and SB 771, I hereby acknowledge that I have received and reviewed the information regarding concussions published by the United States Department of Health and Human Services Centers for Disease Control and Prevention (CDC) available online at http://www.cdc.gov/headsup/youthsports/index.html, including the Fact Sheet for Parents, the Fact Sheet for Athletes, and the Fact Sheet for Coaches (if applicable). For additional information, I understand that I may call1-800-232-4636 or go to http://www.cdc.gov/headsup/youthsports/index.html. *
COVID-19 INFORMATION - I, on behalf of my child(ren) or myself, acknowledge and understand that the novel COVID-19 virus is an extremely contagious virus and is believed to be spread mainly from person to person contact and that the Carroll County Government does not warrant or guarantee that you, your child(ren), your spouse, or anyone else will not be exposed to or infected with the COVID-19 virus as a result of my or my child(ren)'s participation in the Program. I have independently evaluated the risks of being exposed to or infected by the COVID-19 virus and have determined to participate or allow my child(ren) to participate in the Program. Finally, understanding those risks, I, for myself, my child(ren), my spouse, or legal representatives, heirs, and assigns, hereby agree to assume full responsibility and liability for the risk of bodily injury, illness, permanent disability, and/or death which may result from exposure to or infection with COVID-19 before, during, and after participating in the Program. Due to the strenuous nature of some activities, the participant, or if the participant is a child, the child(ren)'s parent or guardian is encouraged to consult with a physician concerning the participant's fitness to participate in the Program. *
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