2012 Girl’s Tryouts Registration

admin January 4, 2012 0

Girl’s Xtreme Tryouts Feb 19

Step 1 of 3 – Player Registration

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Player Name*

First
Last
Ages
ParentName*

First
Last
Parent Email*
Address*

Street Address
Address Line 2
City

State
Zip Code
Phone*
Position*

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
Total
$0.00
Shirt Size
Short Size

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