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2012 Boy’s Tryout Registration
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Men’s
Terry Crowley, Director
Coach Jeff Goldberg
John Devoe
Matt Cahill
Don Goldstein
David Adams
Mike Macleod
Matt Papinetti
Mike Shutowick
Rich Speno
Bill Leahy
Women’s
Rachel Woolford
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Gear
2012 Boy’s Tryout Registration
admin
January 4, 2012
0
Boy’s Xtreme Tryouts March 4, 2012
Player Name
*
First
Last
Tryout Time
*
U11: 2019 & 2020. 8-9:30am
U13: 2017 & 2018. 9:30-11am
U15:2015 & 2016. 11-12:30pm**
U17/U19:2014 & 2013. 1-2:30pm
Please select the appropriate tryout time according to your player’s age level.
**OPEN TO 8TH GRADERS THAT CURRENTLY ATTEND CATHOLIC SCHOOL OR WHO WILL NOT BE ATTENDING ST. THOMAS AQUINAS
Player Graduation Year
*
2020
2019
2018
2017
2015
2014
2013
ParentName
*
First
Last
Parent Email
*
Enter Email
Confirm Email
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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Nevada
New Hampshire
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New Mexico
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North Carolina
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Ohio
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
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West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Phone
*
Position
*
Attack
Midfield
Defense
Goalie
Insurance and Waivers
Health Insurance Company
*
Policy Number
*
By agreeing below, I acknowledge that I have read and understand this form and further understand the terms herein are contractual and not a mere recital.
*
I agree
In consideration of participating in the Florida Xtreme Lacrosse Program, the player named above and the parent or guardian do hereby agree for ourselves, our heirs, executors and administrators, to release, hold harmless
and forever discharge Florida Xtreme Lacrosse Program and their officers, staff, administrators, volunteers, sponsors and representatives and assigns, for and against any and all claims, actions, cause of actions, suits, judgments, and demands whatsoever directly or indirectly in connection the player’s participation in the Florida Xtreme Lacrosse Program.
TREATMENT/MEDICAL RELEASE AUTHORIZATION
*
I agree
I/we being the legal guardians of the applicant authorize the staff of the Florida Xtreme Lacrosse Program and its agents permission to request treatment to ensure the well being of our dependent. I certify that he is in good health and able to participate in the scheduled games.
Please explain any physical limitations and/ or required medical attention that is necessary for your son.
Payment
Florida Xtreme Lacrosse Program uses PayPal for registration payment. Please be sure to complete payment when registering. If you do not receive a confirmation email, then you have not completed payment and are not fully registered.
Florida Xtreme Tryouts
Price:
$25.72
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