www.LuckyLax.com
Lucky Lax Middle School Clinic
Come join the fun! Lucky Lax is featuring an instructional clinic for Middle School Girls (grades 6th-8th). Beginners as well as experienced players are welcome to sign up. Improve your fundamentals, learn advanced skills, and participate in game play. Develop your individual skills and team play as you take your game to the next level!
When?: Session 1: "Getting into the Game" : July 5th & 6th 2 pm-6 pm
Session 2: "Step up your game" : July 26th & 27th 2 pm-6 pm
Where?: The Field Sports Facility of Sports Ohio, 6400 Cosgray Road, Dublin, OH 43016 (directions available on website)
Cost: $ 80 for each session. cost includes tshirt
If registering for both session 1& 2 special price available of $140
Please write check to LUCKY LAX and send to the address below
How to sign up: Print the registration form. Fill out and send to: Lucky Lax at 334 East Kanawha Ave, Columbus, OH, 43214 with payment (*$30 fee for returned checks)
What to bring: Lacrosse stick, eye gear, turf or running shoes, mouth guard and water bottle. No cleats
Questions?: Call Trish Derwart at 614-352-4727
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Please circle the session (s) you are registering for: Session 1 Session 2
Player’s name: ___________________________________________ Date of Birth: _________ grade: _______
Address: ________________________________________________ city: ____________________
state: ______Zip code: _____________ phone 1: ______________________
Player’s email: please PRINT clearly________________________________
Previous lacrosse experience (no experience needed): _________________________ position: ______________________
School currently attending: _________________________________
Parents name: ____________________________________________
Parent’s e-mail: please PRINT clearly_ ______________________________
Emergency contact: _________________________________phone: _______________________________
How did you hear about us?___________________________ League T-shirt size (please circle): S M L XL
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 unforeseeable, 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 hereby 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: _________________________________