EASTWOOD YOUTH LACROSSE (Grades 3-8 Instructional and Recreation Program and K-3 Developmental Program) 2014 SUMMER REGISTRATION MAIL-IN AT ANY TIME PRIOR TO MAY 31 Registration Fee: $35.00 (grades 3-8 Program) $25.00 (K-3 Developmental) Proof of Current Grade - Copy of Report Card Required For More Information Call: Mark Shattuck @ 463-5443 Larry Bousquet @ 474-6074 or e-mail EYLA@earthlink.net 1
EASTWOOD YOUTH LACROSSE REGISTRATION PACKET 2014 Hello Eastwood Youth Lacrosse Player! Please follow the instructions listed below to register for the Eastwood Youth Lacrosse 2014 season. Please feel free to copy and pass these instructions and forms on to any friends who have not played before. REMEMBER, THE DEADLINE TO REGISTER IS MAY 31, 2014. Parents - Please note the "volunteer" section on the registration form. We appreciate your support and consideration in volunteering to help out this season! MAIL-IN INSTRUCTIONS: 1. Fill in the following 3 forms a. Registration form b. Medical Authorization Form c. Waiver and Release 2. Make a COPY of the top section of the player's report card from this year. (We need proof of grade only, not course averages.) 3. Write a check payable to Eastwood Youth Lacrosse Association, Inc. for $35.00 (grades 3-8 Program) or $25.00 (K-3 Developmental Program) 4. Mail all of this (Steps 1-3) BY MAY 31 TO: Eastwood Youth Lacrosse Association P.O. Box 493 Syracuse, NY 13206 2
EASTWOOD YOUTH LACROSSE 2014 BOYS AND GIRLS GRADES 3-8 INSTRUCTIONAL AND RECREATIONAL PROGRAM GRADES K-3 DEVELOPMENTAL PROGRAM Important Dates for the Season: What When Where Registration BEFORE MAY 31 MAIL-IN TO: Eastwood Youth Lacrosse Association P.O. Box 493 Syracuse, NY 13206 Orientation Meeting Friday May 30 at 6 pm Sunnycrest Park (Henninger Stadium Field) Program Begins Week of June 9 Henninger Fields/Eastwood Heights Program Ends Week of July 14 Program Structure: Team Name CURRENT Grade Game Day rd th Boys 3/4 3 & 4 Monday/Sunnycrest Boys 5/6 5 & 6 Tuesday/Eastwood Heights Boys 7/8 7 & 8 Wednesday/Sunnycrest rd th Girls 3/4 3 & 4 Monday/Sunnycrest Girls 5/6 5 & 6 Tuesday/Eastwood Heights Girls 7/8 7 & 8 Wednesday/Sunnycrest Boys/Girls Developmental Program (K - 2) K, 1st, 2nd Thursday/Eastwood Heights Fee Deadline Questions? Fee includes reversible jersey (to keep), insurance, use of playing fields, loaned equipment (helmets, shoulder pads, gloves). REGISTRATION DEADLINE IS MAY 31 (MAIL-IN) Mark Shattuck - 463-5443 or Larry Bousquet - 474-6074 or e-mail EYLA@earthlink.net 3
EASTWOOD YOUTH LACROSSE PLAYER REGISTRATION 2014 Player's Name: Mailing Address: Male ( ) Female ( ) Birth Date: City: Zip: Player's Home Phone: e-mail address: CURRENT Grade: School Attending: Father Mother Contact Name Home Phone Work Phone Cell Phone Guardian Parent/Guardian - PLEASE READ CAREFULLY BEFORE SIGNING Lacrosse is a full contact, physically demanding sport. As with any contact sport, injuries, and even death, are possible. As a parent or guardian of the above applicant for participation in programs sponsored by the Eastwood Youth Lacrosse Association, Inc., I hereby give my consent and approval for participation. I assume all risks and hazards incidental to such participation, including transportation to and from such activities, and hereby waive, release, absolve and indemnify, and agree to hold harmless the Eastwood Youth Lacrosse Association, Inc., its directors, officers, sponsors, supervisors, coaches, helpers, and other participants, including persons transporting the participant to and from activities, for any claim arising out of injury or death to the applicant. Signature of Parent/Guardian Date 4
Eastwood Youth Lacrosse Association, Inc. 2014 AUTHORIZATION FOR MEDICAL TREATMENT OF MINORS NAME OF MINOR BIRTH DATE IDENTIFY ALLERGIES OR SPECIAL CONDITIONS I/WE, BEING THE PARENTS(S) OR LEGAL GUARDIANS(S) OF THE ABOVE NAMED MINOR, DO HEREBY APPOINT (THE COACHES NAMES GO HERE): NAME ADDRESS PHONE 1. 2. TO ACT IN MY/OUR BEHALF IN AUTHORIZING UNEXPECTED MEDICAL, SURGICAL CARE AND HOSPITALIZATION FOR THE ABOVE NAMED MINOR(S) DURING THE PERIOD OF MY/OUR ABSENCE FROM: 5/1/14 THROUGH 8/1/14 THIS DOCUMENT SHALL BE PRESENTED TO A PHYSICIAN, DENTIST OR APPROPRIATE HOSPITAL REPRESENTATIVE AT SUCH TIME AS UNEXPECTED MEDICAL, DENTIST, SURGICAL CARE OR HOSPITALIZATION MAY BE REQUIRED. 1. PARENT GUARDIAN SIGNATURE ADDRESS PHONE WITNESS SIGNATURE ADDRESS PHONE HOSPITAL COVERAGE FOR THE ABOVE NAMED MINOR(S): 1. INSURANCE COMPANY I.D. OR CONTRACT NUMBER HOSPITAL COVERAGE FOR THE ABOVE NAMED MINOR(S): 2. INSURANCE COMPANY I.D. OR CONTRACT NUMBER FAMILY PHYSICIANS: 1. NAME AND NUMBER FAMILY PHYSICIANS: 2. NAME AND NUMBER 5
GRADES K-8 EASTWOOD YOUTH LACROSSE ASSOCIATION, INC. 2014 AMATEUR ATHLETIC MINOR WAIVER AND RELEASE OF LIABILITY IN CONSIDERATION OF BEING ALLOWED TO PARTICIPATE IN ANY WAY IN THE EASTWOOD YOUTH LACROSSE ASSOCIATION, INC. ATHLETICS/SPORTS PROGRAMS, AND RELATED EVENTS AND ACTIVITIES, THE UNDERSIGNED: 1. AGREE THAT THE PARENT(S) AND/OR LEGAL GUARDIAN(S) WILL INSTRUCT THE MINOR PARTICIPANT THAT PRIOR TO PARTICIPATING HE OR SHE SHOULD INSPECT THE FACILITIES AND EQUIPMENT TO BE USED, AND IF THE PARTICIPANT BELIEVES ANYTHING IS UNSAFE, HE OR SHE SHOULD IMMEDIATELY ADVISE HIS OR HER COACH OR SUPERVISOR OF SUCH CONDITION(S) AND REFUSE TO PARTICIPATE. 2. ACKNOWLEDGE AND FULLY UNDERSTAND THAT EACH PARTICIPANT WILL BE ENGAGING IN ACTIVITIES THAT INVOLVE RISK OF SERIOUS INJURY, INCLUDING PERMANENT DISABILITY AND DEATH, AND SEVERE SOCIAL AND ECONOMIC LOSSES WHICH MIGHT RESULT NOT ONLY FROM THEIR OWN ACTIONS, INACTIONS OR NEGLIGENCE, BUT THE ACTION, INACTION OR NEGLIGENCE OF OTHERS, THE RULES OF PLAY, OR THE CONDITION OF THE PREMISES OR OF ANY EQUIPMENT USED. FURTHER, THAT THERE MAY BE OTHER RISKS NOT KNOWN TO US OR NOT REASONABLY FORESEEABLE AT THIS TIME. 3. ASSUME ALL THE FOREGOING RISK AND ACCEPT PERSONAL RESPONSIBILITY FOR THE DAMAGES FOLLOWING SUCH INJURY, PERMANENT DISABILITY OR DEATH. 4. RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE THE EASTWOOD YOUTH LACROSSE ASSOCIATION, INC., OR ITS AFFILIATED ORGANIZATIONS, ADMINISTRATORS, DIRECTORS, OFFICERS, AGENTS, VOLUNTEERS, COACHES, AGENTS, REPRESENTATIVES, AND EMPLOYEES OF THE ORGANIZATION, OTHER PARTICIPANTS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND, IF APPLICABLE, OWNERS AND LESSORS OF PREMISES USED TO CONDUCT THE EVENT, ALL OF WHICH ARE HEREINAFTER REFERRED TO AS "RELEASEES", FROM ANY AND ALL LIABILITY TO EACH OF THE UNDERSIGNED, HIS OR HER HEIRS AND NEXT OF KIN FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES ON ACCOUNT OF INJURY, INCLUDING DEATH OR DAMAGE TO PROPERTY, CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE. I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARY. PARENT OR GUARDIAN (SIGNATURE /RELATIONSHIP) DATE PARENT OR GUARDIAN (SIGNATURE / RELATIONSHIP) DATE PRINTED NAME OF PARENT OR GUARDIAN PRINTED NAME OF PARTICIPANT ADDRESS OF PARTICIPANT 6
Developmental & Instructional Lacrosse Program Sponsored by Eastwood Youth Lacrosse Association REGISTER: Separate Divisions for Girls and Boys Grades K - 3 Geared to first time players. No equipment needed. Sticks provided if needed. Soft ball used. Instructional sessions followed by non-contact intramural games. Shirts for players to keep. Thursday evening sessions from June 12 to July 17. Mail-in to: Eastwood Youth Lacrosse Association P.O. Box 493 Syracuse, NY 13206 Before May 31 Registration Fee: $25 per player For Information: Call Mark Shattuck @ 463-5443 or email EYLA@earthlink.net 1770311v3 7