Beaches Lax League

Registration

Event Details

Beaches Aloha Lacrosse League

Girls Summer Lax League Grades 4-12

Season Runs June 23rd - July 28th, 2010

Sessions will be held on Wednesday mornings:

- 9am-11am - Beginner Session (0-2 yrs exp)

- 11am-1pm - Advance Session (3+ yrs exp)

Select your Event:

Player Info

First Name:*
Last Name:*
Address 1:*
Address 2:
City:*
State:*	FL
Zip Code:*
Email Address:*

Player Details

Date of Birth:*
Current Grade:*
School Name:*
Positions:*	GK A M D
Years Played:*
Reversible Size:*

Special Instructions

Special Instructions:
Insurance Provider:*
Insurance Policy Number:*

Parent / Guardian 1 (Primary Contact)

First Name:*
Last Name:*
Email Address:*
Home Phone:*
Work Phone:
Mobile Phone:

Parent / Guardian 2

First Name:
Last Name:
Email Address:
Home Phone:
Work Phone:
Mobile Phone:

* I / We, understand this payment is non-refundable.

* I agree not to hold entities of MCC Sports, Inc., its officials and associates, or its officers responsible for any physical, mental, or emotional injury that could or may result from sports competition. I certify that my daughter/legal minor is in good health, has passed a recent physical in the past year and is not presently ill. I understand that sports can be dangerous and have no problems with my daughter participating in the sport of lacrosse. I agree to show good sportsmanship and not degrade officials, or other parents and athletes at the private lessons. I (we) recognize that failure to obey good sportsmanship practices will result in dismissal of player, parent, or coach from the tournament and expulsion from the venue without refund. Any legal infraction will be prosecuted should a staff member/official of MCC Sports be threatened or harmed in any way. I grant MCC Sports permission to use my daughter’s name, likeness, or picture in any printed media or form of advertisement. I fully renounce all claims upon MCC Sports for reimbursement for use of this material. PARENT AUTHORIZATION: I/We, the parent(s) or guardian(s) of the above named, give my/our approval for our child to participate in Beaches Aloha Lacrosse League. I/We assume all risks and hazards incidental to such participation and I/We do waive, release, absolve, indemnify and agree to hold harmless MCC Sports Incorporated, Beaches Aloha Lacrosse League, South Beach Park and Sunshine Playground, The City of Jacksonville Beach, their board members and directors, sport commissioners and their committee members, sponsors, supervisors, participants and persons transporting my child to and from activities for any claim arising out of an injury to my/our child, except to the extent and in the amount covered by accident or liability insurance for designated sport, if any. In an emergency, if above designated family physician cannot be reached, I authorize the child named below to be treated by another physician. I authorize staff of MCC Sports to assist my child in the event of a medical emergency.

Electronic Signature - Please Enter Parent/Guardian 1's First and Last Name

ZappSports