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Indoor Winter LACROSSE Registration Form 

Player’s name_________________________________ grade__________ DOB_________

Parent’s name_____________________________________ email_______________________________

Address ______________________________________________________________________________

Previous seasons played_________ Emergency contact name/#__________________________________

Medical concerns:________________________________________________________

Accident disclaimer:  I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 year of age or older and mentally competent to enter into this waiver.

Parent/guardian signature _________________________________________________________  date____________

*********If there’s bad weather, we are canceled for the night. *********

Please print this document and bring the form and the payment to the first practice.
Check are made payable to Upper Perk Lax Club.

Here is the link to the registration form.
http://files.LeagueAthletics.com/Images/Club/13285/Indoor Winter LACROSSE Registration Form.docx