www.LuckyLax.com
"Get Back into the Game!"
A) High School Girls Varsity League: Tuesdays beginning 11/6/2007 $125
Play is weekly for 7 weeks *exact times will be posted on website* Games will be one hour in length and will be held between the hours of 6:30-9:30pm. Experience is Necessary. Player should have varsity experience or a coaches recommendation to participate in this league.
B) High School Girls JV League: Wednesdays beginning 11/7/2007 $125
Play is weekly for 7 weeks *exact times will be posted on website* Games will be one hour in length and will be held between the hours of 6:30-9:30pm. No Experience is Necessary.
C) Middle School Girls League: Wednesdays beginning 11/7/2007 $125
Play is weekly for 7 weeks *exact times will be posted on website* Games will be one hour in length and will be held between the hours 6:30-9:30pm. No Experience is Necessary.
Where? Field Sports at Sports Ohio
Dates? High School Varsity: 11/6, 11/13, 11/27, 12/4, 12/11, 12/18, 1/8 High School JV: 11/7, 11/14, 11/28, 12/5, 12/12, 12/19, 1/9
Middle School: 11/7, 11/14, 11/28, 12/5, 12/12, 12/19, 1/9
Equipment: Sticks, mouth guards, and eye-gear are required to participate. Water bottle recommended.
|
Mail Registration Form and Check To: (check should be written to
Lucky Lax) Lucky Lax, 334 East Kanawha Ave, Columbus, OH, 43214 |
*$30 fee for returned checks
REGISTRATION DEADLINE IS OCTOBER 31st
Questions? Feel free to email Trish Derwart or Catherine Leahy with any questions you may have at
luckylax@hotmail.com; Refer to our website for further contact information.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
League Choice: Please Circle Choice(s): A) Varsity $125 B) JV $125 C) Middle School $125 D.) Pre-game Instructional Session $7
Player’s name: ___________________________________________ Date of Birth: _________ grade: _______
Address: ________________________________________________ city: ____________________
state: ______Zip code: _____________ phone 1: ______________________
Player’s email: please PRINT clearly________________________________
Previous lacrosse experience: (middle school; JV; Varsity) _________________________ position: ______________________
School currently attending: _________________________________ Graduation year ____________
Parents name: ____________________________________________
Parent’s e-mail: please PRINT clearly_ ______________________________
Emergency contact: _________________________________phone: _______________________________
League T-shirt size (please circle): S M L XL
How did you hear about us?_____________________________________________
US Lacrosse #________________________________________________________
US Lacrosse provides Insurance to the players during activity. Register at www.uslacrosse.org. Membership is needed to play in Lucky Lax leagues.
Waiver:
This is to certify that I, as parent/guardian with legal responsibility for my minor child or ward, acknowledge that my child or ward will be engaged in activities that involve risk of injury at Field Sports Inc. and/or Sports Ohio, Inc., and I do recognize and assume all risk, whether foreseeable or unforseeable, on behalf of my child or ward, and consent on behalf of my child or ward, in connection with participation in activities or recreation and instruction at Field Sports Inc. On behalf of my child or ward and his/her legal representatives, I hearby release and agree to indemnify Field Sports Inc., their affiliates, administrators, directors, agents, coaches and their employees, other participants, and sponsor agencies, from any and all claims and damages relating to or arising out of my child’s or ward’s involvement or participation in the programs at Field Sports Inc.
Parents name: ______________________________
Signature: _________________________________ Date: ______________
In connection with the Applicant’s participation in Lucky Lax Leagues, the undersigned do
certify that the Applicant/player is in good health, has no physical impairment restricting him or her from playing lacrosse, except as herewith provided in writing to Lucky Lax, and otherwise is able to participate in the program activities. We (are, are not please circle) attaching a statement explaining special physical limitations and/or required medication, if any, (please indicate if the Applicant/player suffers from allergies, asthma, diabetes, restricted activities, etc.). In further consideration of Lucky Lax acceptance of this application, the undersigned, both for himself or herself and on behalf of any minor child for whom he or she is submitting this application, hereby agree(s) to indemnify and hold harmless, Lucky Lax, its officers, directors, coaches, staff, workers,
volunteers, agents, and sponsors from and against any and all liability, claims, actions, lawsuits, losses,
judgments, and demands whatsoever, in law or in equity, arising out of or in any way relating to the Applicant’s participation in any League event, including, but not limited to, personal injuries or injury to property sustained or caused by the Applicant during or as a result of participation by the Applicant in Lucky Lax, Inc. The
Applicant is aware of the fact that lacrosse is a physically demanding and challenging sport in which injuries may occur.
I authorize LUCKY LAX, Inc., and its agent’s permission to request medical treatment as necessary to insure the well being of the applicant.______________(Please Initial)
Parents name: ______________________________
Signature: _________________________________