Team Charlotte Lacrosse

TEAM CHARLOTTE LACROSSE ON-LINE REGISTRATION
No fees are due at this time

All Fields Required.

Player's First Name:

Last Name:

Player's Position:

Secondary Position:

School:

Current Grade:

Mom's Name:

Mom's Cell:

Dad's Name:

Dad's Cell:

Home Phone:

Parent's Email:

Player's Email:

Name of Insured:

Relation to Participant:

Health Insurance Company:

Policy Authorization Number:

Medical Info. Does your child have any allergies, medical conditions, special needs,
or take any medications that would in any way restrict their participation in any Team Charlotte Lacrosse activities?

If Yes, please describe:

Participant Waiver and Release:
In consideration of my participation in Team Charlotte, StickWithUs.org, LLC; MYL, LLC programs, sponsored events and activities, I agree to the following:
A. I hereby grant Team Charlotte Lacrosse and StickWithUs.org, LLC and its successors, assigns and licensees, permission to use pictures taken of my child in publications and other media use, exhibit and display my child's picture in connection with any public materials produced by or for Team Charlotte Lacrosse and StickWithUs.org. This permission is freely given without remunerative consideration of any kind.
B. 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 with participation in a lacrosse event and related sports conditioning activities. I further agree on behalf of myself, my heirs and personal representatives, that Team Charlotte Lacrosse, StickWithUs.org, LLC; MYL, LLC, along with coaches, officials, referees, volunteers, employees, agents sponsors, owners / leasors of premises used to conduct these events, officers and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event. Team Charlotte Lacrosse, StickWithUs.org and MYL, LLC are not responsible for participants fitness, abilities or equipment. Participant legal guardian represents and acknowledges that participant has adequate insurance and agree to assume full responsibility for any and all costs or expenses occasioned by an injury or medical need arising out of participation in the sport of lacrosse or use of premises, facilities or equipment.
C. Medical Attention: I hereby give my consent to Team Charlotte Lacrosse, StickWithUs.org, LLC; MYL; LLC to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of participation in Team Charlotte Lacrosse, StickWithUs.org, LLC; MYL; LLC sponsored or sanctioned events.
D. Readiness to Compete: I will only participate in those competitions or activities which I believe I am physically and Psychologically prepared to participate.
E. Code Of Conduct. Purpose: Team Charlotte Lacrosse is dedicated to providing its participants with a quality lacrosse experience that combines a high level of competition with the opportunity to demonstrate attitude, skill and ability. In its efforts, Team Charlotte is committed to preserving the honor of the game and the true spirit of competition. To help fulfill this mission, Team Carolina Lacrosse expects that all participants abide by the Code of Conduct. Failure to do so may result in immediate expulsion from the team without compensation or refund. Participants are expected to conduct themselves in a manner that honors the game and demonstrates respect for other players, coaches, officials, and spectators. Performing, permitting, encouraging, or condoning actions that are dangerous or demeaning to a player, coach, official or spectator is unacceptable. Participants are not permitted to be in the possession of or under the influence of alcohol, drugs, and/or tobacco products. Participants are not permitted to be in the possession of weapons. Participants are expected to wear all the necessary and required 20 equipment for participation in lacrosse. Participants are expected to report any and all injuries to a member of the coaching staff and event medical staff. Participants are expected to treat all tournament and camp facilities with respect. The team will not tolerate any actions of vandalism or actions that result in damage to property. Team Charlotte Lacrosse will hold participants legally and financially responsible for any and all damages to practice, game or camp facilities at every and all events we participate in. Participants are expected to report on time for all practices, games and scheduled team events. Overnight participants: When not participating in games or events, overnight participants are required to adhere to and follow the daily itinerary. Itineraries will be given out to the players by the coaches before we depart for an event and updated as needed. In the evenings (after “light out”), participants must remain in their room and are not permitted to leave the hotel or dorm for any reason. Overnight participants are not allowed to drive or ride in personal vehicles between the time they arrive at an event until the time they depart. Overnight participants must give their car keys to the head coach. In the event of an emergency, instructions will be included in the daily itineraries on how to contact Team Charlotte staff members.

Signature of Participant:

Date:

FOR ANY PARITICPANT WHO IS NOT YET 18 YEARS OLD: As legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child to participant in Team Charlotte Lacrosse and any StickWithUs.org, LLC and MYL, LLC sponsored events and activities and I accept each of the above conditions, especially the waiver and release set forth in paragraphs A-E.

Signature of Parent:

Date:

I have read, understood, and agreed with the above information:

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