Hinsdale Central Boys Lacrosse Club Summer Registration
Registration (Please
print clearly)
Player Last Name ___________________________________ Grad. Year 2011 ____ 2012 ____ 2013____ 2014
____
Player First Name ___________________________________ Player Phone _____________________________________
FatherÕs/Guardian Name _____________________________ Father Phone _____________________________________
MotherÕs/Guardian Name _____________________________ Mother Phone ____________________________________
Street ____________________________________________ Email 1 _________________________________________
City _____________________ State
____ Zip _________ Email 2 _________________________________________
U. S. Lacrosse Membership Number_____________________ Email
3 _________________________________________
U.S. Lacrosse Membership
Summer tournaments typically
require a playerÕs U. S. Lacrosse membership number as part of their registration
due to the additional insurance coverage it provides. Obtain or renew your membership online (www.uslacrosse.org/membership)
and enter the number in the space provided above. The annual fee for a high school player is $35.
Payment $250 for JV, $425 for Varsity - DEADLINE: May 15, 2010
Make check payable to: Hinsdale Central Boys Lacrosse Club.
Mail to: Hank Kelly, 133 Ann St., Clarendon Hills, IL 60514
Select the
appropriate program
I. VARSITY PROGRAM – Sign me up:
_____
¤ Open to current HCHS
Frosh, Sophs, Juniors.
¤ 7 practice sessions weekday evenings (June
8, 15, 22, 25, 29, July 6, 13).
¤ High School Summer League (vs. other
area H.S. Lacrosse teams) – 7 Games between June 7-16 (1 weekend game, 1
weekday game.)
¤ Chicago Lacrosse Cup Tournament, Vernon
Hills, June 14 – June 16.
¤ True Lacrosse Summer Classic
Tournament June 25 to June 26.
¤ $425 Includes all practice, coaching, Summer
league fees and tournament fees.
II. JV PROGRAM – Sign me up: _____
¤ Open to current HCHS
Frosh, Sophs
¤ 7 practice sessions
weekday evenings (June 8, 15, 22, 25, 29, July 6, 13).
¤ High School Summer
League (vs. other area H.S. Lacrosse teams) – 7 Games between June 7-16
(1 weekend game, 1 weekday game.)
¤ True Lacrosse Summer
Classic Tournament June 25 to June 26.
¤ $250 Includes all practice, coaching and
Summer league fees.
Current Freshman and Sophomores can
sign up for the JV Program or the Varsity program. The Varsity team will be selected by the coaches from all
players that sign up for the Varsity program. If a freshman or sophomore player signs up for the
Varsity, and is placed on the JV team, the player will be refunded the $200
difference.
Physicals
Players cannot play or practice
without a current physical on file in the Hinsdale Central Athletic
Office. Physical forms are
available in the HC Athletic Office and are valid for 365 days from the
examination date. HCHS offers
sports physicals in June at the high school which would cover the Õ09 Summer
program and Õ10 Spring lacrosse regular season. Check the high school website or call the athletic
department for details.
Medical Information
If any medical information such as
your physicianÕs name, insurance provider or emergency contact has changed
since registering for the regular 2010 spring season, please note change(s)
here: ______________________________________
___________________________________________________________________________________________________
Release
Emergency Authorization: I the undersigned, or the parent or
legal guardian of the participant if a minor hereby authorize the coaches,
assistant coaches, or parents of team members acting in the capacity of
supervisors/vehicle drivers as my Agents, to consent to medical, surgical or
dental examination and/or care at any hospital. In an emergency if I cannot be reached, the individual whose
name I have provided to the Club as ÒEmergency ContactÓ may also authorize any
necessary action or care.
Amateur Athletic Waiver and Release of
Liability: In
consideration of being allowed to participate in any way in the Hinsdale
Central Boys Lacrosse Club athletic sports program, related events and
activities the undersigned acknowledges, appreciates and agrees that: (1) The risk of injury from the
activities involved in the program is significant, including the potential for
permanent paralysis and death, and while particular rules, equipment and
personal discipline may reduce this risk, the risk of serious injury does
exist; and (2) I knowingly and freely assume all such risks, both known and
unknown, even if arising from the negligence of the releasees or others, and
fully assume full responsibility; and (3) I willingly agree to comply with the
stated and customary terms and conditions for participation. If, however, I observe any unusual and
significant hazard during my presence or participation, I will remove myself
from participation and bring such to the attention to the nearest official
immediately; and (4) I, for myself and on behalf of my heirs, assigns, personal
representatives and next of kin, hereby release and agree to indemnify and hold
harmless the Hinsdale Central Boys Lacrosse Club, its officials, agents,
employees, other participants, sponsoring advertisers and, if applicable,
owners and lessors of premises used to conduct an event (ÒReleaseesÓ), from any
and all claims and liabilities of every kind and nature, with respect to any
and all injuries, disability, death, or loss of damage to persons or property,
whether arising from the negligence of the releasees or otherwise. I have read this release of liability and
assumption of risk, fully understand its terms, understanding that I have given
up substantial rights by signing it, and sign it freely and voluntarily.
Waiver: This is to certify that I, as parent/guardian with
legal responsibility for this participant, do consent and agree to his/her
release as provided above of all the Releasees, and, for myself, my heirs,
assigns, and next of kin, I release and agree to indemnify and hold harmless
the Releasees for any and all liabilities, incident to my minor childÕs
involvement or participation in these programs as provided above, even if
arising from their negligence.
Parent/Guardian
Signature___________________________________________________________________ Date___________________________