Fort Collins Lacrosse

FCYL - Youth Winter Indoor Lacrosse - 2007 - $125

Player First Name: *
Player Last Name: *
Player DOB: *
Grade: *
School: *
Home Phone: *
Mailing Address: *
City: *
State:
Zip: *
Mother's Name:
Mother's Email:
Mother's Home Phone:
Mother's Work Phone:
Father's Name:
Father's Email:
Father's Home Phone:
Father's Work Phone:
Emergency Contact Name: *
Emergency Contact Phone: *
I have read the waiver and agree and I acknowledge the contents therein:		(by checking this box, you acknowledge that you have read the waiver and agree)
US Lacrosse Number: * (players must register with US Lacrosse)		Your son must have a valid membership number through 1/31/08 before participating in practices or games. Visit US Lacrosse here.
US Lacrosse Expiration Date: *

By its nature, participation in athletics includes risk of injury, which may result in severity from minor, to long-term catastrophic injury and even death. Although serious injury is not common in supervised athletic activities, it is impossible to eliminate this risk. Participants can and do have the responsibility to help reduce the chance of injury. Players must obey all safety rules, report all physical problems to their coaches and inspect their own equipment. By signing this participation form, we acknowledge that we have read and understand this warning. We hereby release Fort Collins Youth Lacrosse, its staff, agents, and volunteers from any financial responsibility or liability from injury to the participant in connection with participation in this athletic activity.

Any questions concerning registration contact: John Newman at 970-484-5743 or
Jim Juneau at 970-204-9821. Any issues with on-line registration, send email to: fclax-registration@fclax.com.

Online Payments