Lumberjack Registration Form

All Fields Required.
A separate form must be completed for each participant.

Player's First Name: 
Last Name: 
Date of Birth: 
   
School: 
Grade: 
Lacrosse Experience: 
Position: 
Mom's Name: 
Mom's Cell: 
Mom's Work Number: 
Dad's Name: 
Dad's Cell: 
Dad's Work Number: 
Home Street Address: 
City: 
State: 
Zip: 
Home Phone: 
Parent's Email: 
Name of Insured: 
Relation to Participant: 
Health Insurance Company: 
Policy Authorization Number : 
 
Player's Legal Guardian(s) Name(s) (If you are 18 years or older you
may type your own name:
Medical Info. Does your child have any allergies, medical conditions, special needs,
or take any medications that would in any way restrict their participation in any StickWithUs.org lacrosse activities?  
If Yes, please describe:
Disclaimers
Equipment Guarantee. I hereby guarantee the safe keeping and timely return or reimbursement of the replacement value of any and all equipment and uniforms issued to my child by StickWithUs.org.
I agree with the above disclaimer:
Photo Release & Waiver. I hereby grant StickWithUs.org and its successors, assigns and licensees, permission to use pictures taken of my child in publications and other media use, exhibit and display my child's picture in connection with any public materials produced by or for StickWithUs.org. This permission is freely given without remunerative consideration of any kind.
I agree with the above disclaimer:
Participant Waiver & Release In consideration of my participation in
StickWithUs.org, LLC; MYL, LLC programs, sponsored events and activities,
I agree to the following:

A. Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event and related sports conditioning activities. I further agree on behalf of myself, my heirs and personal representatives, that StickWithUs.org, LLC; MYL, LLC, along with coaches, officials, referees, volunteers, employees, agents sponsors, owners / leasors of premises used to conduct these events, 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. StickWithUs.org and MYL, LLC are not responsible for participants fitness, abilities or equipment. Participant legal guardian represents and acknowledges that participant has adequate insurance and agree to assume full responsibility for any and all costs or expenses occasioned by an injury or medical need arising out of participation in the sport of lacrosse or use of premises, facilities or equipment.

B. Medical Attention: I hereby give my consent to StickWithUs.org, LLC; MYL; LLC to provide through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of participation in StickWithUs.org, LLC; MYL; LLC sponsored or sanctioned events.

C. Readiness to Compete: I will only participate in those competitions or activities which I believe I am physically and Psychologically prepared to participate.

D. Code Of Conduct . Purpose: StickWithUs.org and MYL, LLC seeks to provide a great lacrosse experience for all its players, parents, and coaches. We believe that a quality organization is measured by it's conduct and attitude both on and off the field. We feel that how the game is played is even more important than winning itself. In pursuit of this goal, we have adopted this Code of Conduct and Sportsmanship policy. Players: As a member of a team and an organization your actions reflect on your teammates and the rest of our organization. You are expected: To play the game for the game's sake; for the fun of it. To treat your coach, teammates, officials and opponents with respect. To avoid inappropriate behavior during practices, games, team or league sponsored events. To control your emotions. To make a reasonable attempt to attend all practices and games. To attempt to win through your skills, effort and tactics; to always be fair. To take victory modestly and defeat graciously. To adhere to the rules of the game & confirm to the rules established by our league. Parents You are not only a supporter of your child but a role model as well. Your actions reflect upon you child, his team and league. You are expected: To remember that the game is for your child, not for you. To encourage and support your child in meeting his responsibilities to the team and organization. To set a good example by your conduct and sportsmanship. To avoid inappropriate behavior during practices, games, team or league sponsored events. To refrain from directing the play of the game. To recognize and praise skillful play by both teams. To give positive reinforcement, not to yell or ridicule. To appreciate the fact that the coach is a volunteer. Not to argue with or criticize the officials or coaches, particularly in the company of your child. Violations: Minor violations to the code of conduct should be resolved by the head coaches. Serious, continued or unresolved violations will be directed to the league commissioner. Players who continue to violate the code of conduct will be asked to sit out portions (as outlined in the leagues game rules) or all of games and possibly suspension from the League. Parents or coaches that infringe on or continue to violate the code of conduct will be asked to leave the organization. We encourages good sportsmanship and respect from all its participants. It is imperative that parents, players, and coaches, maintain responsible and respectful behavior.

Signature of Participant: 
Date: 

FOR ANY PARITICPANT WHO IS NOT YET 18 YEARS OLD: As legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child to participant in any StickWithUs.org, LLC and MYL, LLC sponsored events and activities and I accept each of the above conditions, especially the waiver and release set forth in paragraph A.

Signature of Parent: 
Date: 
I have read, understood, and agreed with the above information:

Registration Fee-Required. $225.00 per player. Registration Deadline is Friday, September 4, 2009 Refund Policy:  $35.00 of the registration fee is non refundable regardless the reason for cancellation.  The complete refund policy is posted on www.StickWithUs.org.  Returned check policy:  A re-deposit fee of $15.00 will be charged for all returned checks. 

Total Amount Due: $

I will mail a check      I will pay online

Then After clicking the submit button, you will be taken to a page to be printed for your records and you can either pay online or mail your form with payment to:
 StickWithUs.Org
PO Box 77043
Charlotte , NC 28271

The submit process may take up to a minute. Please do not press the Submit button more than once.