2011 RAVEN LACROSSE CAMP
PLAYER APPLICATION

(leave no space blank)                                                
Players Name__________________________________________________
                               
Position:      Attack         Midfield          Defense          Goalie    ( must circle one )

Address____________________________________________________________

City________________________________ State_______  Zip Code____________

Date of Birth_______________ Age_______ Grade ______  Years of Exp._______

School/Team________________________________________________________

Parent Email (Mandatory)______________________________________________
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US Lacrosse Membership Number_____________________ Exp. Date_________
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I understand that: 1) My child is in good physical condition and has had a physical examination by a certified
physician within six months prior to camp; 2) I am hereby waiving and releasing the Raven Lacrosse Camp, its
Director and its Staff from any and all liability for injuries incurred by my child while attending and participating in
Camp even if arising from negligence; 3) I will pay all costs incurred by the Camp as a result of any failure by my
child to respect and maintain School facilities and/or observe Camp rules and regulations causing property damage.
Medical Consent
In the event that I am unable to give parental consent, I hereby authorize the Physician/Hospital Staff at any Hospital
to provide care to include diagnostic procedures and medical treatment to my child, who is a minor.
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By signing below, I am entering into a legal contract willfully and faithfully. I am aware that my donation of $40.00 is
completely NON-REFUNDABLE for any reason.
(leave no space blank)

Parental Signature___________________________________ Date____________

Print Parents Name___________________ Parents Cell Phone:________________

Parents Home Phone__________________ Parents Work Phone_______________

Medical Insurance Coverage____________________ Policy Number____________

Emergency Contact other than Parent_____________________ Phone__________

Office Use Only - Do Not Write Below This Line _________________________________________________________________

PLAYER______________________________________________________   AMOUNT CREDIT TOWARDS SPRING FEE________________

 

 

Text Box: US Lacrosse Participant Waiver & Release of Liability For participation in a RAVEN Lacrosse Program Instructions:      1.) Each Player should read the statement below before completing and signing this Waiver & Release Form. 2.) Parents / Guardians should read the statement below before completing and signing this Waiver & Release Form. Agreement:     In consideration of my membership in US Lacrosse and of my participation in the sponsored activities of Ravens Boys Lacrosse Camp Program, I acknowledge, agree to and understand that: 1.)        Readiness To Compete: Voluntary and of my own free will, I elect to participate as a member of the Ravens Lacrosse Boys Camp Program. I will only participate in those US Lacrosse competitions and activities sponsored by Ravens Boys Lacrosse for which I believe I am physically and psychologically prepared to compete. 2.)        Readiness To Compete: I hereby give my consent to US Lacrosse and to Raven Boys Lacrosse, Canyon Crest Academy and the host organization of any US Lacrosse sponsored event to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted through the course of my participation in sponsored lacrosse activities. 3.)        Waiver & Release of Liability:      I am fully aware of and appreciate the risks associated with participation in a lacrosse event, including the risk of catastrophic injury, paralysis and even death, as well as other types of damages and loss. I further agree on behalf of myself, my heirs, and personal representatives, that US Lacrosse, Raven Boys Lacrosse, Canyon Crest Academy, the host organization, and sponsors of any US Lacrosse event, along with their coaches, volunteers, employees, agents, officers and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event(s). My signature below is my acknowledgement that I have read and understood every provision of this Waiver and Release of Liability, and that I agree to abide by it. Print Players Name____________________________________________________________________ Players Signature_____________________________________________________________________ US Lacrosse Membership Number________________________________ Exp. Date______________ Street Address_____________________________________________________________________________ City_______________________________________________ State________  Zip Code__________________ Print Parents Name_________________________________________________________________ Parents Signature X___________________________________________________________________ Date______________ Email: ___________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Text Box: RAVEN LACROSSE CAMP AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY FORM Read Carefully before signing In consideration of being allowed to participate in any way in a Ravens Boys Lacrosse athletic sports programs, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1.       The risk of injury from activities involved in this program is significant, including the potential for permanent injury and death, and while particular rules, equipment, and personal discipline may reduce the 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, assume full responsibility for my participation; and, 3.       I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of 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 HOLD HARMLESS the Ravens Boys Lacrosse Team, its Coaches, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event {“RELEASEES”}, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without inducement. This is to certify that I, as parent / guardian with legal responsibility for this participant, do consent and agree to his 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 from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from negligence. ( leave nothing blank or this form will be returned for completion) X_______________________________________________________  Date Signed_________________                       ( Parent’s / Guardian’s Signature ) Home Phone____________________________________________________________________  Work Phone_____________________________________________________________________ Cell Phone_______________________________________________________________________