Check In: 30 minutes prior to clinic
start. Mouthguards and goggles,
sticks, water bottle with name on it, required.
Check (X) the clinic(s) below that you
would like to attend
___Sunday Jan. 6 11 am-1
pm Defense
$25
____Sunday Jan. 13 9-11 am
Stickwork $25
____Sunday Feb. 10 9-11 am
Shooting $25
____Sunday Feb. 10
9am-11am Goalie
Clinic $25 * note time
change
Registration is limited to 60 field players based on
applications received with a
non-refundable clinic fee of $25 for each clinic.
All players must be current US Lacrosse Members prior to the clinic.
Membership number and expiration date is required with registration.
Registration for USL membership is available on line at
www.uslacrosse.org/membership. Signed
waiver below is also required with registration.
Clinic confirmations will be posted on the nys web site
www.nyslacrosse.org front page.
Mail Application to :Beth Stone 26 Saybrook Pl. Buffalo, NY 14209
US
LACROSSE MEMBERSHIP NO (required)_______________EXP
Date____
(membership number and exp. date is located on label of USL Magazine)
E
Mail: ____________________________________________________________
Parent's Name: _________________________________ (Please Print)
Parent Signature
______________________________ Date _______________
Amateur Athletic Minor Waiver and Release of Liability
PLAYER'S NAME (PRINTED)__________________________________________
SCHOOL:__________________________ GRADUATION YEAR:____________
In consideration for being allowed to participate in any way in the Western New York Chapter of US Lacrosse athletics/sports program, 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 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 foregoing risk and accept personal responsibility for damages following such injury, permanent disability or death.4. Release, waive, discharge and covenant not to sue US Lacrosse, Inc. and their Chapters, the WNY Lacrosse Clinic Clinicians or volunteers, the Western New York Chapter of US Lacrosse, Nichols School, Amherst Central Schools, or any other practice site used for these clinics and the athletic training and medical staffs working at these practices, tournaments and venues; their affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organizations, and other respective sponsoring agencies, sponsors, advertisers, and, if applicable, owners and leasers used to conduct the events or practices for 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 part by the negligence of the 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 VOLUNTARILY.
PARENT/GUARDIAN_________________________________________________________________ (SIGNATURE/RELATIONSHIP)
DATE_________________________________________________________________
PRINTED NAME OF PARENT/GUARDIAN_________________________________________________________________
ADDRESS OF
PARTICIPANT_______________________________________________________________________
EMERGENCY PHONE NUMBERS_______________h
______________cell_____________emergency