Grizzlies 3rd-5th Grade Clinic: Saturday, Dec. 7th 12:00-1:15pm @ Bartram Trail HS (back practice fields)
FREE Girls Lacrosse Clinic with BTHS and Grizzlies Lacrosse Coaching staff for girls in 3rd through 5th grade! Equipment check out available (Stick and goggles). All players must have their OWN mouthguard and must bring their own water. Cleats recommended.
Email address *
Player Name (First & Last) *
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Player Grade *
Player Current School *
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Equipment (Note: ALL players MUST have their own mouthguard!!) *
Parent/Guardian 1 Name *
Your answer
Parent/Guardian 1 Email *
Your answer
Parent/Guardian 1 Cell Number *
Your answer
Parent/Guardian 2 Name
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Parent/Guardian 2 Email
Your answer
Parent/Guardian 2 Cell Number
Your answer
US Lacrosse Membership (not required for Free Clinic but IS required for Spring season- if you have a membership please include your membership number.)
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Emergency Contact Name & Number *
Your answer
Any Health Concerns/Problems *
Your answer
AUTHORIZATION TO OBTAIN MEDICAL ATTENTION, WAIVER AND RELEASE OF LIABILITY, the parent or legal guardian of the child, hereby grant permission to Grizzlies Lacrosse personnel to authorize and obtain medical and/or dental emergency care or treatment from a physician, hospital, medical clinic, emergency medical technician or other medical provider should the child become ill or injured while participating in Grizzlies Lacrosse activities organized or sponsored by or otherwise relating to Grizzlies Lacrosse and its affiliates, while away from his/her home, at any times when neither a parent nor a legal guardian is available to authorize emergency treatment.As the parent or legal guardian of the child, and by registering him/her as a participant in the Grizzlies Lacrosse program, (and all related events and activities, including, without limitation, practices, games, clinics, camps, tournaments and travel), I do hereby acknowledge, and agree that: 1. The risk of injury from the activities involved in this program is significant. I have independently reviewed and evaluated the risks and determined that the child may participate in the program, and I assume all responsibility, with my full knowledge and acceptance of the risk. 2. I, for myself, and on behalf of the child, the child's successors, heirs, assigns, and personal representatives, agree that Grizzlies Lacrosse, including all participants, officials, coaches, assistants, chaperones, agents, directors, managers, members, shareholders, officers, employees, sponsors, advertisers, owners or lessors of premises used in conducting the program, are hereby released from any and all liability and claims for any injuries, disability, death, or loss or damage to person or property of any kind whatsoever, incident to the child's participation or involvement in the Grizzlies Lacrosse program, even if caused by the negligence or gross negligence of Grizzlies Lacrosse or its agents. 3. The child will comply with the stated and customary rules and regulations for participation in the programs. 4. I acknowledge that Grizzlies Lacrosse has encouraged me as the parent or legal guardian of the child to consult with and seek approval from their physician prior to commencing the program. I am aware of and have disclosed any known medical conditions, allergies, or medications present in regard to the child, and release Grizzlies Lacrosse from any and all liability and claims for any injuries, disability, death or loss or damage to person or property incurred on the part of the child while participating in Grizzlies Lacrosse programs as a result of said medical conditions, allergies, or medications. I further release Grizzlies Lacrosse from any and all liability and claims for any injuries, disability, death or loss or damage to person or property incurred on the part of the child while participating in Grizzlies Lacrosse programs as a result of any and all unknown medical conditions, allergies, and medications present in regard to the child. 5. I authorize the use of any and all photos or any other images of the child participating in Grizzlies Lacrosse related activities for use on the website or in promotional or other materials on behalf of Grizzlies Lacrosse.I have read the above, fully understand its terms, and sign it freely and voluntarily, both on my behalf and the behalf of the child. *
Required
Electronic Signature: I agree read and agree to the waiver above (Parent/Guardian signature) *
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A copy of your responses will be emailed to the address you provided.
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