Player Info, Emergency and Insurance Waiver for The Launch 2017
For the college coach's book, please complete this player information, emergency and insurance waiver.
Today's Date *
mm/dd/yy
Your answer
Athlete's Name *
First and Last name
Your answer
Graduation year *
Year expecting to graduate from high school
What is the current high school you attend? *
Name of high school.
Your answer
Lacrosse position *
position most desired to play
What is your high school coach's email address(es)? *
type in email address of coach
Your answer
If you are currently on a lacrosse travel team or club, please write in the name of the club.
Name of travel lacrosse team. (If not applicable, leave blank)
Your answer
Did you take the SAT exams yet? *
If you did take the SAT exam, what were your scores?
Your answer
What is your current one mile timed run time? *
How many minutes do you run one mile in?
Athlete's Email Address *
Most frequently checked email
Your answer
What colleges or universities are you most interested in?
Type in name or list of colleges you are interested in attending.
Your answer
DO YOU HAVE AN INSTAGRAM,FACEBOOK, or TWITTER account, we can tag you in?
What are usernames? EX) @TheLaunchShowcase
Your answer
Home Address *
Street address, state, and ZIP code
Your answer
Birth Date *
Athlete's date of birth (mm/dd/yy)
Your answer
Home Phone *
phone number
Your answer
Athlete's Mother's Name *
First and last name.
Your answer
Mother's Cell Phone *
Mother's personal cell phone number
Your answer
Athlete's Father's Name *
First and last name
Your answer
Father's Cell Phone *
Father's personal cell phone number
Your answer
Neighbor or Relative #1 *
List the NAME, ADDRESS, and PHONE NUMBER of a neighbor or relative that can assume temporary care of your child if you can not be reached
Your answer
Physician's information *
NAME, OFFICE PHONE NUMBER, ADDRESS, TOWN, AND STATE.
Your answer
Dentist information and policy number *
NAME, OFFICE PHONE NUMBER, ADDRESS, TOWN, STATE, AND POLICY NUMBER
Your answer
Allergies and medication
List all allergies and medications that your athlete takes regularly
Your answer
Existing Conditions
List all existing illnesses, broken bones, and impending or recent surgeries
Your answer
Medicine
Include all medicine being taken now, include insulin. Include all dosages.
Your answer
Parent's Electronic Signature *
Please give consent by typing your full name in the box below, and include the date.
Your answer
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