Boys Lacrosse Registration Form

Total Player Fee: $100 Make payable to: North Idaho Lacrosse, 511 E. Foster Ave, Coeur d’Alene, ID 83814

Athlete’s Last Name: _________________________ First Name: ________________________ Middle Init: _____

School: __________________ Birth Date: _______ Grade: _______ Height _______ Weight _______

Street: ___________________________________ City: __________________________ St: ___ Zip: __________

Phone: _____________ Email: ____________________________________________________________________

Parent (Guardian) Information (if under 18 years old):

Mother’s Name: ___________________ hm phone: ____________ wk phone: ____________ cell: _____________

Father’s Name: ____________________ hm phone: ____________ wk phone: ____________ cell: _____________

Player resides with? __________ (mother/father/both)

Prior lacrosse experience: ____ (Y/N). Describe: _____________________________________________________

Since his/her last athletic physical examination, has this player:

	Yes	No
1. Had surgery
2. Been hospitalized
3. Been under a physician's care
4. Had a serious illness
5. Had an injury rquiring a physician's care
6. Been rendered unconscious
7. Started taking any new medications
8. Developed any new drug allergies
9. Developed any health problems

Please explain any yes answers:

My child ____ should ____ or should not have a physical examination prior to participation in high athletics.

Health insurance needed: ___yes;___no, if yes, your child will be covered by the North Idaho Lacrosse program for a maximum of $25,000 with a $100 deductible.

Insurance Company ___________________________

Insurance Policy Number ____________________________

Boys Lacrosse Registration Form

I am aware that athletics are violent contact sports and that playing or practicing will be a dangerous activity involving MANY RISKS AND INJURY. I understand that the dangers and risks of playing or practicing in athletics include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the muscular skeletal system and serious injury or impairment to other aspects of my body, general health and well being. I understand that the dangers and risks of playing or practicing in interscholastic athletics may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life.

Because of the dangers of interscholastic athletics, I recognize the importance of following the coaches' instructions regarding playing techniques, training and other team rules, etc., and agree to obey such instructions.

In consideration of Viking/Lake City Lacrosse permitting me to play in the Viking/Lake City Lacrosse program and to engage in all activities related to the program, but not limited to playing lacrosse I hereby assume all the risks associated with lacrosse and agree to hold the Viking/Lake City Lacrosse program, Coeur d’Alene/Lake CityHigh School, its employees, agents, representatives, coaches and volunteers harmless from any and all liability, actions, causes of action, debts, claims or demands of any kind and nature whatsoever which may arise by or in connection with my participation in any activities related to a high school team. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and for all members of my family.

Date ________________ Signature of Student_______________________________________________________

I _____________________________ am the parent/legal guardian of __________________________________ (player). I have read the above warning and release and understand its terms. I understand that interscholastic athletics are VIOLENT CONTACT SPORTS involving many RISKS OF INJURY, including but not limited to those risks outlined above.

In consideration of Viking/Lake City Lacrosse permitting my child/ward to try out for the Viking/Lake City Lacrosse and to engage in any activities related to the program, including, but not limited to, trying out, practicing or playing in interscholastic athletics, I hereby agree to hold the Viking/Lake City Lacrosse program, Coeur d’Alene/Lake City High School, its employees, agents, representatives, coaches and volunteers harmless from any and all liability, actions, causes of actions, debts, claims, or commands of every kind and nature whatsoever which may arise by or in connection with participation of my child/ward in any activities related to a club team. The terms hereof shall serve as a release for my heirs, estate, executor, administrator, assignees and for all members of my family.

Date ____________ Signature of Parent/Guardian ___________________________________________________