313 LAX CLUB U15 AND U13 FALLREGISTRATION FORM
PLEASE FAX this document to 586-279-0250 OR EMAIL TO
[ ] FALL TOURNAMENT PACKAGE $235 INCLUDES:
1. ENTRY FEES BOO BASH 10 V 10OXFORD, MI| OCT 26, 2013 4. FOUR 90-MINUTE TEAM PRACTICES
2. ENTRY FEES D TOWN 7 V 7 PONTIAC, MI | DEC 28, 2013 5. COLLIEGIATE LEVEL INTRUCTORS
3. 313 LAX CLUB CUSTOM SUBLIMATED REVERSIBLE 6. 313 LAX CLUB CUSTOM SUBLIMATED TEAM SHORTS
Section 1 - Primary Info * INDICATES MANDATORY FIELD
*Primary Email (MAIN CONTACT SOURCE)______
*Parent First Name ______*Last Name______
*Primary CELL # ______
*Address______
*City______*State______*Zip______
SECTION 2 - Secondary Parent/Guardian (OPTIONAL)
Email Address______
First Name ______Last Name______
Parent 2 Cell # ______
Section 3 - PLAYERINFO
Player EMAIL#______
*First Name______*Last Name______
*DOB ______HGHT______WGHT______
*Calendar Year of High School Graduation ______*YRS OF LACROSSE EXPERIENCE______
*High School ______(please list current or future high school attending)
*Primary Position (choose one) Attack_____Midfield_____ Defense_____ LSM_____ Goalie_____ FOM______
*PLAYER CELL# (______)______
TELL US ABOUT YOU! (Other sports played, previous team played on, academic achievements, community service, etc.)
______
313 LACROSSE LLC ENROLLMENT AGREEMENT & RELEASE
The Participant desires to participate in a program of 313 Lacrosse LLC, doing business as GP Select, 313 Lacrosse Club, GP Elite, or 313 Lacrosse Academy. This form is an important legal document. It is critical that you read and understand it completely. After you have done so, please print your name legibly and sign below. In this document, the term “Participant” includes both the on-the-field Participant and the parent or legal guardian, if Participant is less than 18 years of age. Participation in the sport of lacrosse may result in injury or death to Participants. Participant desires to participate in the sport of lacrosse despite these risks. Participation in the 313 Lacrosse LLC program is expressly conditioned upon the following agreement by the Participant:
1. Participant assumes all risks of injury or death sustained while participating in the sport of lacrosse or while on or about the premises, and waives all liability against 313 Lacrosse LLC, the Grosse Pointe Public Schools, the Sports Academy, Elite Indoor Sports their officers, employees and all affiliated entities.
2. Participant releases, discharges, indemnifies and holds harmless 313 Lacrosse LLC, the Grosse Pointe Public Schools, the Sports Academy, Elite Indoor Sports, their officers, employees, agents, officials and all related entities from any and all claims, demands or causes of action that are in any way connected with participation in the sport of lacrosse or use of the premises, facilities or equipment, and including any negligence on the part of 313 Lacrosse LLC, the Grosse Pointe Public Schools, their officers, employees, agents, officials and all affiliated entities.
3. 313 Lacrosse LLC is not responsible for Participant’s fitness, abilities, or failure of any equipment.
4. Participant represents and acknowledges that Participant has adequate insurance and agrees 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 the premises, facilities or equipment.
5. Participant acknowledges that during the course of their activities, 313 Lacrosse LLC may take Participant’s photograph or video. Each Participant hereby grants 313 Lacrosse LLC permission to use any such photograph or video for use in materials promoting 313 Lacrosse LLC. Such use may include publication in program, general advertising, posters, flyers, television and any other vehicles that may be distributed or shown to or otherwise seen by large numbers of individuals and potential patrons of GP Select or 313Lacrosse LLC. Participant waives all rights to any financial remuneration of any kind.
I have read and I understand this Agreement. I warrant that I have the right and the authority to execute this Agreement on behalf of myself and the Participant (if under the age of 18). I assume full responsibility for the terms and conditions of this Enrollment Agreement & Release, and will indemnify and hold harmless 313 Lacrosse LLC. For any claims brought by or on behalf of Participants to this Agreement.
______
Name of Participant Date Signature of Participant (if 18) or Parent/Guardian
PAYMENT & INFO SECTION
VISIT FOR:
1] ONLINE PAYMENT
2] COMPLETE PROGRAM DETAILS AND DESCRIPTIONS
3] DIRECTIONS/MAPS TO ALL VENUES
4] COMPLETE AND DETAILED SCHEDULES
5] Paying by check? Payable to:
313 LACROSSE LLC.
28220 Harper Ave
Saint Clair Shores, MI 48081
Fax 586-279-0250
Office 586-498-5500
Director “coach B” 810-523-3699