REGISTRATION
Please return this form and the US Lacrosse form with your check
payable to LENAPE VALLEY LACROSSE CLUB
**Forms/Checks due by MARCH 1st!!**

Student/Athlete's Name: _____________________________      Grade: _____________

School: ____________________     Male____  Female____        Date of Birth: ________

Mailing Address: __________________________          Mother's Name: ______________

Town:_________________        Zip Code:_____           Father's Name:_______________

Home Phone:_________________                               Email Address:_______________

Work Phone (Mom):_________________          Emergency Contact: ________________

Work Phone (Dad):_________________       Emergency Phone #:________________

Any Medical Restrictions?  If yes, please explain: _____________________________________________

_____________________________________________________________________________________
Allergic to any Medicines?  If yes, please explain: _____________________________________________

_____________________________________________________________________________________

Parental Activities: (Must be Completed for Registration to be Processed) Our Lacrosse Club is growing. If you do not want to volunteer please contribute an additional $ 25 to support your program.

Asst. Coaching______  Score/Clock Keeper________ Fund Raising _______

Team Parent________                Field Maintenance_________    $ 25 Contribution   ________

          Note:  Signatures are required on the back / 2nd page of this form
 
 
 
 

Page 2 of 2
Student/Athlete's Name: (Print)___________________________                         Grade:___________

Parental Waiver and Consent:
As the parent or legal guardian of the child named above, I hereby give my full consent and approval for my child to participate as a team member of the LENAPE VALLEY LACROSSE CLUB.
I understand that there are certain risks of injury that are inherent in the practice and play of this sport, as well as in traveling and other related activities to my child's participation, and I am willing to assume these risks on behalf of my child.  I hereby certify that my child is fully capable of participation in the designated sport and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed below.
In addition to giving my full consent for my child's participation, I do hereby waive, release and holds harmless the LENAPE VALLEY LACROSSE CLUB, its officers, coaches, sponsors, supervisors and representatives for any injuries that may be suffered by my child in the normal course of participation in the lacrosse program and the activities incidental thereto, whether the result of negligence or any other cause.
I understand that the organization's medical insurance is a secondary policy.  I understand that if an injury occurs, the child will be reinstated only with a note from a physician.

Player & Parents Responsibility for Equipment:
 With respect to Borrowed Equipment, We acknowledge receipt of LENAPE VALLEY LACROSSE CLUB equipment in good condition and agree to return all of it in good condition.
 With respect to Players Own Equipment, We acknowledge that we must have all the equipment required in the Rules of Play for US Lacrosse and that the equipment meets the high standards set by US Lacrosse and will be maintained in good condition. Minimum equipment required is as follows, but not limited to: Helmet, Mouthguard, Shoulderpads, Arm Pads, Gloves, Cleats, Protective Cup and Lacrosse Stick.

Attendance Counts! ~ Lacrosse is a sport that requires skilled, safe play and good teamwork learned through regular team practices. Game playing time may be limited at the coach's discretion should a player incur a number of unexcused absences.  Attendance will be taken at each practice.

New Jersey Junior Lacrosse - Rules of Conduct:
Every effort will be made by all parties, coaches, players, officials and parents involved in New Jersey Youth Lacrosse to create a safe and positive experience.
The attitude, purpose and conduct that adults and players bring to the sport help define its goals.  We seek to create an atmosphere of learning and enjoyment, coupled with good sportsmanship.  We must conduct ourselves in a manner that promotes and teaches these attitudes.  An effective method to achieve this atmosphere is to hold that opposing coaches and officials are engaged in these same goals, and dedicate ourselves to working together to attain the desired lacrosse experience.

Positive Comments At All Times:
--- Negative comments to the other team, its coaches, and referees will result in immediate unsportsmanlike penalties, starting with one minute non-releasable time secured by the offending player or the in-home.
---A second offense by the same player will result in expulsion.  He/she is automatically suspended for the next game.
---A second offense by a coach will result in expulsion from the balance of that game and the following game.
---A second offense by a parent will result in officials escorting the parent from the field.
Any threatening remark or action directed towards an official or coach will result in cessation of the game and forfeiture to the non-offending team.

Refund Policy:
Should you wish to withdraw your child from the program prior to April 15th you would receive 100% of your fee minus the $20 US Lacrosse Youth Membership Fee.  After April 15th there will be no refunds for any reason.

I have read, understand, and will abide by all of the above for the New Jersey Junior Lacrosse League.

________________________________                            _______________________________           _____________
Student /Athlete Signature Required                                   Parent’s Signature Required                             Date