Wesley Chapel Wildcats Lacrosse 2017 Spring Registration and Information Packet This packet will be used for the registration of players for the Spring Season of High School Lacrosse. Included are medical release forms, player code of conduct, and consent about concussions or head injuries, internet release forms, and dues required per player. These dues will offset the costs of field rentals (both practice and game fields), team equipment, uniforms, coaching and referee fees, etc. A physical examination form is attached and must be completed and signed by a physician. If you have had a sports physical since May 2016, you may submit a copy of it instead of the one supplied. All players must include a copy of this year s (2016-2017) high school ID card with the picture clearly visible. The physical and photo ID are required by the FGCLL and are kept in a team binder. A player will not be allowed on the PCLA roster without this information. Please fill out all areas legibly. US Lacrosse Membership PCLA Lacrosse requires a valid membership to US Lacrosse and the membership needs to be valid through May 2017. Fees for membership are outside PCLA Lacrosse and should be paid directly to US Lacrosse. Their website is www.uslacrosse.org. The fee from US Lacrosse for yearly membership is $35 and will cover your insurance to participate in scheduled practices and league games. PCLA Lacrosse Registration Packet - 2017 Page 1
2017 Spring Registration and Information Packet Players Name: High School Attending: Date of Birth: Grade Level: Position: Address: City: Shirt Size (Circle one): Small / Medium / Large / XL Zip: Short Size (Circle one): Small / Medium / Large / XL Jersey Number Preference: / / (Please list three Returning players will get preference) Players Email: Players Cell: Parent/Guardian Name Email Cell Spring Season Registration Fee: $395 Total Paid: $ Mail checks payable to PCLA or pay online at www.pascolax.org *** All players MUST be a current US Lacrosse Member (must be valid thru May 2017) Go to www.uslacrosse.org to register for $35 US Lacrosse Number: Expiration: PCLA Lacrosse Registration Packet - 2017 Page 2
2017 Dues and Fundraising Player Name: Dues Contract By signing this document, I understand that I am responsible for the payments of club dues in the amount of $395. Each player will be required to sell tickets as part in a Club Fundraiser to be announced. All Club Dues are non-refundable. Fundraising Commitment The player is required to participate in the club s fundraiser to be announced. Players Printed Name Parent or Guardian s Printed Name (if player is younger than 18 yrs. of age) Signature of Player, Parent, or Guardian Date (Parent or Guardian must sign if player is younger than 18 yrs.of age) PCLA Lacrosse Registration Packet - 2017 Page 3
Consent to Medical Treatment / Waiver and Release Form Consent to Medical Treatment If the above named participant needs emergency medical treatment and neither parent is available at the time of an injury, consent is hereby granted for such emergency treatment as may be considered necessary in the opinion of the attending physician. Waiver and Release Form In consideration of my membership as a player at PCLA and also for my participation in PCLA, recognized events, I agree to the following: Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated participation in a lacrosse event. I further agree on behalf of myself, my heirs and personal representatives, that PCLA, the host organization, and sponsors of any PCLA, recognized event, along with coaches, officials, referees, volunteers, employees, agents, officers and directors of these organizations, shall not be liable for any injury, loss of life or other losses or damage occurring as a result of my participation in the event. Readiness to compete: I will only compete in those PCLA competitions or activities in which I believe I am physically and psychologically prepared to participate. For any participant who is not yet 18 years old: As legal guardian of this participant, I hereby verify by my signature on page eleven that I have read and understand each of the above conditions for permitting my child to participate in any PCLA recognized event, and I accept each of the above conditions. Players Printed Name Parent or Guardian s Printed Name (if player is younger than 18 yrs. of age) Signature of Player, Parent, or Guardian Date (Parent or Guardian must sign if player is younger than 18 yrs. of age) PCLA Lacrosse Registration Packet - 2017 Page 4
Medical Information/Emergency Contacts Medical Information: I hereby authorize the staff of PCLA to act in accordance with their best judgment in any emergency requiring medical attention. I further waive, hold harmless and release PCLA and it s staff and Pasco County Schools from any and all claims for any injury or illness incurred prior to or during the program. I further state that I have no knowledge of any physical impairment that would be affected by my child s participation in this activity. Primary Medical Insurance: Policy Number: Physician s Name: Insurance Contact Number: Physician s Office Number: Hospital of Choice: Known Allergies and other Medical Information Emergency Contact Information if parent cannot be reached: Name: Name: Contact Number: Contact Number: Signature Parent / Guardian: Printed Name: Date: PCLA Lacrosse Registration Packet - 2017 Page 5
Player Code of Conduct Player Code of Conduct Participating in the PCLA team and program is a privilege and student - athletes are expected to display appropriate behaviors and a positive image for the program. Student-athletes who do not comply with team rules and/or fail to uphold the code of conduct will be subject to disciplinary action at the digression of the coaches. ACADEMICS: You are a student first and are expected to maintain your school s academic standards. If at any time your grades fall below standards, the coaching staff should be notified. Coaches may request you to submit grades at the end of grading period. All players are studentsathletes, with emphasis on STUDENT. Academics come first, but players are highly encouraged to be well organized and have good time - management skills. EXCUSED ABSENCES: If you are going to miss a practice/game for any reason, the head coach must be notified. When possible, notification should occur before the practice/game. In all instances, notification should be made as soon as possible. If coaching staff notices habitual or significant absences or lateness, a conference will be set up to discuss further action. UNEXCUSED ABSENCES: Unexcused absences will not be tolerated. After two unexcused absences, you will be suspended for one half of a game. Another Unexcused absence will result in another one game suspension and a conference will be set up with the coaching staff to discuss your involvement in the team. You will be expected to suit up and attend the game(s) you are suspended from. PRACTICES AND GAMES: Players are required to attend all practices and games. Arriving late, or being absent from practice will reflect on that team member s playing time during games and will result in extra conditioning for that person or the entire team as decided by the coaches. No use of cell phones during practice. Use of appropriate language on the field is expected at all times. Arrive to all practices and games in a timely manner, prepared and ready to play at the scheduled time. This includes uniforms, practice jerseys, footwear, water, safety equipment, no jewelry, etc. DUAL SPORT ATHLETES: It is expected that all dual sport athletes will provide the coaching staff with an official schedule of their other obligation so that a practice and game schedule can be decided upon by the player and coaching staff PCLA Lacrosse Registration Packet - 2017 Page 6
Player Code of Conduct Cont d PLAYING TIME: Playing time is at the coach s discretion and is based on many factors including but not limited to: practice, game attendance, attitude, knowledge of the game, and skill level. At Modified Team (JV) levels all athletes will be given a chance to compete. At high school varsity level, playing time is not guaranteed to anyone. ATTITUDE: As a player of PCLA you are expected to do the following as a responsible, committed player on this team: Attend all team practices and games, arrive to all practices and games in a timely manner, prepared and ready to play, demonstrate good sportsmanship and citizenship on and off the field, and respect your coaches, captains, and teammates. At any time the coaching staff feels your attitude is detrimental to the welfare of the team, they will take the appropriate actions. All instances will be handled on a case-by-case basis. SPORTSMANSHIP: There will be no vulgarity, profanity, trash talking or taunting at practices and/ or games. In accordance with the National Federation of State High School Associations and US Lacrosse rules, any two (2) un -sportsmanship will result in ejection from the game and suspension from the following two (2) games. INJURIES: If at any time you suffer an injury, it is your responsibility to inform the coaching staff. The coaching staff will determine what action is to be taken on a player-by-player basis. A medical Doctor s note will be required to return from injury. While injured, players are to attend team practices and games unless the injury does not allow. EQUIPMENT AND UNIFORMS: It is expected that each athlete will treat their equipment and uniform with the upmost care and respect. I understand that the uniform, must be returned when requested by the coaching staff. ZERO-TOLERANCE OFFENSES: Use of illegal drugs, tobacco or alcohol at any club event and/or attending any club event under the influence of illegal drugs or alcohol is a zero-tolerance offense. Possession of illegal drugs, tobacco or alcohol present at a club event will not be tolerated. Distribution of illegal drugs, tobacco or alcohol whether at a club event or not are all zero tolerance offenses. Player s Printed Name Signature of Player_ Parent s Printed Name Signature of Parent_ Date PCLA Lacrosse Registration Packet - 2017 Page 7
Consent about Concussions or Head Injuries Informed Consent about Concussions or Head Injuries Effective July 1, 2012, Florida Statute 943.0438 requires the parent or guardian and a youth who is participating in athletic competition or who is a candidate for an athletic team to sign and return an informed consent that explains the nature and risk of concussion and head injury, including the risk of continuing to play after a concussion or head injury, each year before participating in athletic competition or engaging in any practice, tryout, workout, or other physical activity associated with the youth's candidacy for an athletic team. The Facts: A concussion is a brain injury. All concussions are serious. Concussions can occur without loss of consciousness. Concussions can occur in any sport. Recognition and proper management of concussion when they first occur can help prevent further injury or even death. What is a concussion? A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even or what seems to be a mild bump or blow to the head can be serious. Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost, even if they do not directly hit their head. To help recognize a concussion, you should watch for the following two things among your athletes: 1. A forceful blow to the head or body that results in rapid movement of the head, and 2. Any change in the athlete's behavior, thinking, or physical functioning. Signs and symptoms of concussion that may be reported by a coach or other observer: Appears dazed or stunned Is confused about assignment or position Forgets sports plays Is unsure of game, score or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Can't recall events prior to hit or fall PCLA Lacrosse Registration Packet - 2017 Page 8
Consent about Concussions or Head Injuries Cont d Signs and symptoms that may be reported by the player: Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Does not feel right Both parents/guardians and players are advised to take the Center for Disease Control's free online concussion training at http://www.cdc.gov/concussion/headsup/training/headsupconcussion.html. Under Florida law a player who has a suspected concussion or head injury must be removed from play or practice. Before the player may return to practice or competition, a written medical clearance to return stating that the youth athlete no longer exhibits signs, symptoms, or behaviors consistent with a concussion or other head injury must be received from an appropriate health care professional trained in the diagnosis, evaluation, and management of concussions. In Florida, an appropriate health-care professional (AHCP) is defined as either a licensed physician (MD, as per Chapter 458, Florida Statutes), a licensed osteopathic physician (DO, as per Chapter 459, Florida Statutes), a licensed physician s assistant under the supervision of a MD/DO (as per Chapters 458.347 and 459.022, Florida Statutes) or a health care professional trained in the management of concussions. I have read and understand this consent form, and I volunteer to participate. Player Name: Signature: Date: As parent or guardian, I have read and understand this consent form and I give permission for my child, named above, to participate. Parent/Legal Guardian Name: Signature: Date: _ PCLA Lacrosse Registration Packet - 2017 Page 9
Internet Release Form Parental / Guardian Consent Form It is our procedure to seek permission before using player s information or images on publications. Publications may include but are not limited to: Cable television productions, videos, brochures, pamphlets, DVD, CD Rom programs or Web pages. I do hereby authorize PCLA to use, in perpetuity, the player s likeness, voice or performance which has been recorded on tape, film or other media. This information will be used for entertainment purposes only. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to PCLA and such rescission will take effect upon receipt by the club. Please check one of the following choices: I/We GRANT permission for my player s photo/image, jersey number and name to be published on the lacrosse web site. I/We DO NOT GRANT permission for photo/image that includes my player s full name and jersey number to be published on the lacrosse web site. Players Printed Name Parent or Guardian s Printed Name (if player is younger than 18 yrs. of age) Signature of Player, Parent, or Guardian Date (Parent or Guardian must sign if player is younger than 18 yrs.) PCLA Lacrosse Registration Packet - 2017 Page 10
Checklist When turning in your completed registration make sure it includes all of the following: Pages 2-10 of the registration packet Payment in form of a check or online payment Copy of 2016-17 Student High School ID Card Copy of US Lacrosse Membership valid until May 2017 or after Recent Sports Physical filled out, signed and dated by your doctor PCLA Lacrosse Registration Packet - 2017 Page 11