Instructions, Los Alamos Youth LAX 2018 Registration Form To register, please Paper free process or downloads available at:

Transcription

1 Instructions, Los Alamos Youth LAX 2018 Registration Form To register, please Paper free process or downloads available at: Register ONLINE, or, complete this packet (download available on the above web page at Pay registration fee: $125 payable to Los Alamos Youth Lacrosse. Pay any needed rentals or uniforms (one check is fine) Player does not have to join US Lacrosse before registering with LAYLAX, but he or she must show proof of membership before participating on the field at practice or in games. Either bring forms and payment to one of the walk-in registration sessions January 23 or January 25, 2018, or mail them to: Los Alamos Youth Lacrosse Evelyn Bond, Treasurer 443 Pruitt Avenue White Rock, NM 87547

2 2018 Los Alamos Youth Lacrosse Registration Form Registering Parent/Guardian Information Login Address Name Street Address City State Zip Home Work If you are creating this account for your Family you can add a second adult such as your Spouse, a Guardian or a Grandparent, who also need to receive team information. Second Parent/Guardian Information Login Address Family Administrator? (login can change acco! Yes! No Name Street Address City State Zip Home Work

3 Communications Preferences Parent 1 (Registering Parent/Guardian): Share Registering Parent/Guardian & s with Team? Home Work Receive Upcoming Event Remiders Games Practice Parent 2 (Second Parent/Guardian): Share Second Parent/Guardian & s with Team? Home Work Receive Upcoming Event Remiders Games Practice Contact s you wish us to share? Can Either Adult Help? (We TRULY need any help you can give!) Parent 1 Parent 2 Head Coach Assistant Coach Team Parent Team Communicaton Homecoming (Fall) Spring Potluck Score Keeping Team Website Board Member Unavailable at this time Emergency Information Alternate Emergency Contact Name (not a parent) Primary Additional! Cell! Land Line! Cell! Land Line Medical Insurance Provider Group ID All Children Same Info? Policy Number! Yes! No Physician Name Dentist Name

4 Child 1 Information First Name Last Name Nickname Birth Date Grade M/F Medical Issues? Preferred Team Mix! Boys/Coed! Girls/Co-ed! Girls Only Preferred Age Group! High School! Youth U15! Youth U13! Youth U10 Alt. Medical Insurance or other notes Login Address - enter if ok for coach to text or use app for communication with Child's cell phone - enter if ok for coach to text or use app for communication with Share & with Team? Receive Upcoming Event Reminders? Games Practice Child 2 Information First Name Last Name Nickname Birth Date Grade M/F Preferred Team Mix! Boys/Coed! Girls/Co-ed! Girls Only Preferred Age Group! High School! Youth U15! Youth U13! Youth U10 Medical Issues? Alt. Medical Insurance or other notes Login Address - enter if ok for coach to text or use app for communication with Child's cell phone - enter if ok for coach to text or use app for communication with Share & with Team? Receive Upcoming Event Reminders? Games Practice

5 Child 3 Information First Name Last Name Nickname Birth Date Grade M/F Preferred Team Mix! Boys/Coed! Girls/Co-ed! Girls Only Preferred Age Group! High School! Youth U15! Youth U13! Youth U10 Medical Issues? Alt. Medical Insurance or other notes Login Address - enter if ok for coach to text or use app for communication with Child's cell phone - enter if ok for coach to text or use app for communication with Share & with Team? Receive Upcoming Event Reminders? Games Practice Child 4 Information First Name Last Name Nickname Birth Date Grade M/F Preferred Team Mix Preferred Age Group! Boys/Coed! Girls/Co-ed! Girls Only! High School! Youth U15! Youth U13! Youth U10 Medical Issues? Alt. Medical Insurance or other notes Login Address - enter if ok for coach to text or use app for communication with Child's cell phone - enter if ok for coach to text or use app for communication with Share & with Team? Receive Upcoming Event Reminders? Games Practice

6 Assumption of Risk, Agreement to Hold Harmless and Emergency Release Form As the parent/legal guardian of the athlete to be registered, I understand that playing or participating in any sport can be a dangerous activity involving many risks of injury. By signing below, the athlete/parent/legal guardian hereby assumes all risks associated with participation and agrees to hold Los Alamos Youth Lacrosse Association and all agents, coaches, and volunteers harmless from any and all liability, actions, causes of actions, debts, claims, or demands of any kind and release any assumption of risk for your heirs, estate, executor, administrator, assignees, and for all members of your family. Additionally, by signing below the athlete/parent/legal guardian understands, in the event they cannot be reached, this form hereby grants permission to the physician selected by coaches or representatives of Los Alamos Youth Lacrosse to hospitalize and secure proper treatment (including surgery) for the athlete. Moreover, by the parent/legal guardian signing this form, they are agreeing to abide by all Los Alamos Youth Lacrosse Association rules and reasonable authority of the coaches and Association representatives and that the athlete has been deemed by a physician to be physically able to participate in running and recreational activities. Medical Consent Authorization In the event of an injury, accident, illness or other emergency, and if the above stated physician cannot be reached, I authorize my child,, to be treated by certified emergency personnel, such as emergency medical technicians, emergency room physicians, and other emergency room personnel such as nurses and laboratory technicians. I agree to accept financial responsibility for the costs related to this medical treatment. Signature Printed Name of Participant Name of Authorized Parent or Guardian (printed) Signature of Authorized Parent or Guardian Date

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8 US Lacrosse Compete with Class Pledge I pledge to COMPETE with CLASS and HONOR THE GAME I will honor the history of lacrosse and commit to maintaining the core values of the game's culture. I will recognize the value of safe and fair play by teaching, enforcing and playing by the letter and spirit of the game. I will practice and encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game, practice or other lacrosse event. I will place the emotional and physical well-being of our players ahead of any personal desire to win. I will support coaches and officials working with players in order to encourage a safe, positive and enjoyable experience for all. I will do my very best to make the sport fun for everyone who participates. I will ask all family members and fans to be tolerant and inclusive by treating other players, coaches, fans and officials with high regard and respect. Los Alamos Youth Lacrosse Pledge I will be inclusive of everyone: teammates, opponents, coaches, parents and spectators, regardless of their appearance, background, beliefs, or personal choices. I am a witness. I will not participate in physical, verbal, or cyber bullying in any way, and if I see it, I will say something to someone who can help. ( ) I will own and be accountable for my behavior, and accept mistakes and corrections as a part of life and sport. I will abide by team, league, and US Lacrosse rules. Player Name: Parent Name: Signatures Player: Parent: Coach: Date: Date: Date:

9 Los Alamos Youth Lacrosse Equipment Rental Request Spring 2018 * Note that All Equipment is available on a first come first served basis. Unavailable Equipment is the responsibility of the player RENTAL AGREEMENT I,, (parent/guardian) have received in my possession the items listed below on (date) and agree to maintain the equipment to the best of my ability and not to alter the equipment in any way. I also agree to return all items by the date specified. If equipment is worn beyond normal wear, or is not returned by the due date, I understand that my deposit check will be cashed. I understand that maintenance of the equipment is my responsibility once in my possession. Parent/Guardian: Date: Player Last Name Player First Name Player Parent Last Name Parent First Name Parent Equipment Requested Needed? SIZE CHECKED OUT BY RECEIVED BY HELMET YES / NO $35 SHOULDER PADS YES / NO $10 ELBOW PADS YES / NO $10 GLOVES YES / NO $10 STICK, Short YES / NO $10 STICK, Girls YES / NO $10 GOGGLES, Girls YES / NO $10 Rental Fee Payment Check Amt Pd Online Deposit Payment* Check # *$200 Refundable Deposit Check is Required Total Rental Fee Please make two separate checks payable to LAYLAX, or pay Rental Fee Online *Deposit checks will be handed back un-cashed if gear is returned in good working condition Cost