2024 Avino Academy- Summer LACROSSE Registration

NAME*

GENDER*

SCHOOL GRADE:

ENTER ATHLETE'S USA LACROSSE NUMBER

Vist www.usalacrosse.com to purchase $30 annual membership, required for all lacrosse players in the USA, includes numerous member benefits and insurance.

PARENT/GUARDIAN 1 NAME*

ADDRESS*

PHONE NUMBER*

EMAIL

EMERGENCY CONTACT*

NAMEPHONE

PHONE NUMBER*

WHAT SESSION(S) WILL YOUR PLAYER BE PARTICIPATING IN?

HAS YOUR ATHLETE PLAYED LACROSSE BEFORE?

YESNO

IF YES, PLEASE LIST EXPERIENCE BELOW (YEARS/SCHOOL/TEAM)

DOES YOUR ATHLETE HAVE ANY ALLERGIES OR MEDICAL CONDITIONS?*

YESNO

IF YES, PLEASE LIST BELOW

DOES YOUR PLAYER HAVE AN INTEREST IN PLAYING IN TOURNAMENTS?

YESNOMAYBE

HOW DID YOU HEAR ABOUT US?

I PARENT/LEGAL GUARDIAN* , the parent/legal guardian of ATHLETE* agree and make public that I will not hold Avino Lacrosse Academy, coaches, its staff, volunteers, and affiliates, or any other participants responsible for any accidents or injuries that may be sustained in connecting with practicing and playing lacrosse. I understand precautions for safety have been taken. I also understand accidents do happen and I assume responsibility for any losses thereof. I also authorize emergency treatment if it should become necessary and do hereby give my consent for any medical treatment deemed necessary.

Signature*

PAYMENT TYPE

Avino Academy of Lacrosse

ATHLETE INFORMATION

MEDICAL INFORMATION

LEGAL DISCLAIMER

PAYMENT