Registration Form for training children

Registration Form for training children
This registration will allow you to provide contact information and submit payment. Please read through each page carefully to ensure that all information is provided accurately. To complete registration through our secure site, please have your Visa, MasterCard, Discover or PayPal account information available.
Player Information:
Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Current Age
Position(s) Played:
AttackMidfieldDefenseGoalie
# of Years Played
Address
Street Address
Suite or Apt. #
CityState
Postal / Zip CodeCountry
Parent/Guardian Information
Parent/Guardian First Name:
Parent/Guardian Last Name:
Parent/Guardian Home Phone #:
Parent/Guardian Cell Phone #:
Parent/Guardian Email:

Waiver - Release of Liability
I am aware that Lacrosse is an aggressive, physical sport involving severe cardiovascular stress and violent physical contact. I understand that Lacrosse involves certain risks, including but not limited to death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles, and internal organs. I am also aware that equipment used for my protection may be inadequate to prevent serious injury. In addition, I understand that participation in Lacrosse involves activities incidental thereto, including but not limited to travel to and from the site of the activity, participation at sites that may be remote from available medical assistance, and the possible reckless conduct of other participants. I am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death.
Also, in consideration of my participation in 22 Lacrosse, I hereby release, hold harmless and covenant not to sue 22 Lacrosse, LLC, its representatives, its venue providers, and any of its sponsors, lessors, volunteers, referees, employees, instructors, coaches or agents (hereinafter collectively “22L”), from any and all present and future claims for property damage, personal injury, or wrongful death arising as a result of my participation in the Tournament and associated activities, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all such claims, both present and future, that may be made by me, my family, estate, heirs, or assigns. I further agree to defend and indemnify 22L should any claims be asserted against 22L by third parties because of my claims for property damage, personal injury, or wrongful death.
I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of the State of Florida and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further affirm that the venue for any legal proceedings shall be in the State of Florida. I affirm that I am of legal age, or that as a minor I am having a legally recognized parent or guardian execute and I/we are freely signing this agreement. I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies which may be available to me for claims against 22 Lacrosse, LLC or any of the parties listed above.
Terms and Conditions Acceptance
I/We Hereby Accept the Terms and Conditions above.

Medical Information
Emergency Contact Name:
Emergency Contact Primary Phone Number:
Emergency Contact 2 Name:
Emergency Contact 2 Primary Phone Number:
Does the participant have any allergies, present medication, special considerations, etc.:
YesNo
If Yes, Please Explain:
Should be Empty:

Registration Form for training children

Player Information:

Parent/Guardian Information

Waiver - Release of Liability

Medical Information