South Windsor Girls’ Youth Lacrosse
 Registration Form

The South Windsor Girls’ Lacrosse program is holding

Registration for the 2008 season for female students in grades 2 through 8.

We offer a grade 2-4 in-house program & a grades 4-8 intra-town program.

Registration fee for 2-4 In-house is $60

Registration fee for 4-8 Intra-town is $90 by January 1^st.

Registration fee for 4-8 Intra-Town is $100.00 by February 15^th

Registration fee for 4-8 Intra-town is $120.00 thereafter.

*4^th graders need to have completed one year of in-house to play intra-town

Registration forms are located on our Website:

swlacrosse.org

(under the Youth section)

Make checks payable to “SWGYL” and mail to:

SWGYL

P.O.BOX 1169

SOUTH WINDSOR, CT 06074

Once your registration commitment is received we will mail you the USLacrosse forms for completion (US Lax fee is included in your registration fee).  Please return those forms as soon as possible.

For additional information or if interested in coaching please contact:

Karen Richard at 648-4639

South Windsor Girls' Youth Lacrosse Registration
[A Medical Release Form (reverse side) is required for each child]

PLEASE PRINT CLEARLY

Participants Name:_________________________________________

Street Address:  __________________________________________

Town:  ______________________   State:  _______    Zip:  __________

Home Phone:  ________________

Email:____________________________________

Age:  _____   Birth date:  ___________

School:  ________________________________  Grade:  _____

Mother/Guardian Name:  ____________________ Work Phone:  ___________

Father/Guardian Name:  _____________________ Work Phone:  ___________
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PROGRAM FEES:

Program Fees:

(4^th graders need to have completed one year of in-house to play intra-town)

Grades 2nd & 4th (In House):  $60.00

Grades  4-8 (Intra-Town):  Through January 1, 2008     $90.00
                                           Through February 15, 2008  $100.00
                                           After February 14, 2008     $120.00

TOTAL AMOUNT ENCLOSED                                                               

$________

======================================================================

(over)

South Windsor Girls' Youth Lacrosse - WAIVER FOR PARTICIPATION

Please read this form carefully and be aware in registering your minor child/ward for participation in the Lacrosse program, you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of this program.

As a participant, or parent/guardian of a participant, in the lacrosse program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with this program.  I agree to waive and relinquish all claims I or my minor child/ward may have against South Windsor Girls' Youth Lacrosse, Inc., its staff, coaches, and volunteers as a result of participating in the program.  I further agree that the participant has been examined by a physician and is physically fit and able to participate.

I  HAVE  READ  AND  FULLY  UNDERSTAND  THE  ABOVE  PROGRAM  DETAILS  AND  WAIVER  AND  RELEASE  OF  ALL  CLAIMS.
 

Parent/Guardian Signature: __________________________Date: _________
 
 

South Windsor Girls' Youth Lacrosse, Inc.
 MEDICAL RELEASE

Purpose:  To enable parents and guardians to authorize the provision of emergency treatment for children who become injured or ill when parents or guardians cannot be reached.

GRANT CONSENT FOR MEDICAL TREATMENT

As a parent/guardian, I do authorize the treatment of my child _______________________  by a qualified and licensed medical doctor in the event of an accident, injury, sickness, etc.  This release is effective during the period of time in which my child is participating in the South Windsor Girls' Youth Lacrosse, Inc. Spring Lacrosse program and any travel games for the season, including traveling to or from such games.  I also hereby assume the responsibility for payment of any such treatment.  The authority is granted only in the event of an emergency or after reasonable efforts have been made to reach me.

Parent/Guardian Signature:____________________________Date: _________