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    Players Tryout Form

    ! Indicates required information

    2010 Tryout Registration Form
     ! First Name: 
     ! Last Name: 
     ! Street: 
     ! City: 
     ! State: 
     ! Zip Code: 
     ! Home Phone: 
    ! Birthdate: 
     ! Email: 
     ! US Lacrosse # Not your Jersey #: 
    ! Grade Going into Fall 2009: 
     ! Position: 
     ! School Attending: 
     ! Fathers Name: 
     ! Mothers Name: 
     ! EMail: 
     ! Home Phone: 
     ! Cell Phone: 
    MEDICAL/EMERGENCY CONTACT INFORMATION
     ! Emergency Contact: 
    Phone: 
    Relationship to Player: 
    Insurance Carrier: 
    Policy #: 
    Make $25.00 Check Payable To: Xtreme Lacrosse
    687 Deer Park Ave.
    Babylon NY 11702
    WAIVER INFORMATION
    I agree to the following:
    1. WAIVER & RELEASE: I am fully aware of and appreciate the risks, including the risks of catastrophic injury, Paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event.
    I agree on behalf of myself, my heirs and personal representatives, that Long Island Braves Lacrosse, the host organization and the sponsor or sponsors with respect to a Covered Event, together with coaches,
    officials, volunteers, employees, agents, officers and directors of the host organization and any such sponsors shall not be held liable for any injury, loss of life or other loss or damage as a result of my participation
    in practice and events.
    2. MEDICAL ATTENTION: I hereby give my consent to Long Island Braves Lacrosse and the host organization of any Covered Event to provide, through a medical staff of its choice, customary medical/athletic training attention,
    transportation and emergency services as warranted in the course of the player’s participation.
    3. READINESS TO COMPETE: The player will only participate in those Covered Events in which I believe I am Physically and psychologically prepared to compete.
    4. OWNERSHIP AND RESPONSIBILITY OF EQUIPMENT: I understand that as part of my participation I may receive or use equipment, including but not limited to, team uniform, etc., which shall remain the property of the
    Long Island Braves Lacrosse, and which I am responsible to return upon completion of the season, or my departure from the program. I also understand that I am fully
    responsible for all equipment issued to me and shall assure its proper use and care.

       I/we agree with the above  ! 

    ! Indicates required information


       



    Long Island Braves Lacrosse
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