2019 Fall Registration

2019 Fall Registration
*Please read program overview and details ENTIRELY before registering*

* Indicates required field

Participant's Name *

First

Last

Parent/Guardian Email *

2nd E-mail *

2019-2020 Grade *

Program *

Player Experience *

2019-2020 School *

D.O.B. (mm/dd/yyyy) *

Click Here to find your US Lacrosse Membership Number, Click Here for steps to become a member under SEL

US Lacrosse Membership # *

T-shirt size *

Phone Number *

Emergency Phone Number *

Address *

City *

State *

Zip Code *

I'm interested in volunteering as coach *

Yes No

Electras Lacrosse has my permission to use photos of my daughter caputured during program and team events for the team's website and facebook page only. *

Yes No

Please list medical conditions or allergies relevent to participating in athletics *

Additional Comments *

ACTIVITY RELEASE OF LIABILITY

In exchange for participation in the activity of Girls Lacrosse organized by Stapleton Electras Lacrosse ("SEL"), of 4969 Verbena Street, Denver, Colorado, 80238 and/or use of the property, facilities and services of SEL, I agree for myself and (if applicable ) for the members of my family, to the following:

I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by SEL, or the employees, representatives or agents of SEL.
I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge SEL for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of SEL, whether caused by the fault of myself, my family, SEL or other third parties.
I am a current US Lacrosse Member under Stapleton Electras Lacrosse
I agree to indemnify and defend SEL against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of SEL.
I agree to pay for all damages to the facilities of SEL caused by my or my family's negligent, reckless, or willful actions.
I consent to the participation of my daughter, named above in the "Participants Name" box, in the SEL Clinic, and agree on behalf of the above minor to all of the terms and conditions of this Agreement. By signing this Release of Liability, I represent that I have legal authority over and custody of the person named in the "Participants Name" box.
Any legal or equitable claim that may arise from participation in the above shall be resolved under Colorado law.

I have read and fully understand the SEL's Activity Release of Liability and voluntarily surrender certain legal rights. *

Yes

Submit