Detroit City Recreational Lacrosse

Detroit City Recreational Lacrosse

Our recreational lacrosse league is focused on teaching the sport of lacrosse to youth of all ages 3-15, from Little Laxers to early high school exposure. Combined with character development, Detroit City Recreational Lacrosse will be a fun, introductory environment where all are welcome to learn lacrosse and fall in love with the game! Committed to the athletic development of all our athletes, we will be providing all youth of the appropriate age to suit up and compete in regulation games. Fall Lacrosse will run on Saturdays September 16 to October 28, 2023 from 10am-noon. Fall involves an hour of practice and then an hour game each week. ALL Equipment will be provided, minus cleats (which are recommended but not required). Every athlete registration will require a resubmission of this registration form. We cannot wait to see you on September 16! Registration is open for youth 3-15. Girls who are in middle school are recommended to sign up for Detroit United Panthers at www.detroitunitedlacrosse.org/panthersgirls. You can SIGN UP NOW, PAY LATER. PAYMENT IS NOT REQUIRED TO SUBMIT REGISTRATION. FULL SCHOLARSHIPS AVAILABLE ON REQUEST.
Student Name/Nombre del Estudiante *

First NameMiddle NameLast Name
Birth Date/Fecha de Nacimiento*

MonthDayYear
Age of athlete as of April 1st/Edad de el atleta desde el 1 de Abril*
Gender/Género*
Address/Dirección*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian E-mail/ correo electrónico del guardián*
example@example.com
Mobile Number/número de teléfono móvil*
Location Information
Which location would you like your child to attend? (¿A qué lugar le gustaría que asistiera su hijo?)*

Northwest Activity Center, Westside Detroit (18100 Meyers Rd, Detroit, MI 48235)Chandler Park, Eastside Detroit (12200 Chandler Park Dr, Detroit, MI 48213)
Does your child have any lacrosse experience? (¿Tiene su hijo alguna experiencia de lacrosse?)*

Yes, competitiveYes, DCRLYes, clinicsNo, new!Other
Communication will be done via email and by GroupMe. GroupMe communication will be divided up by site and will include site managers. (La comunicación se realizará por correo electrónico y por GroupMe. La comunicación de GroupMe se dividirá por sitio e incluirá administradores de sitio.)*

I understand
IN CONSIDERATION OF my minor child/ward as listed below in this form (“My Child”), being allowed to participate in any way in this Detroit United Lacrosse program, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. The risk of injury to My Child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and2. I, for myself, my spouse, My Child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, IN CONSIDERATION OF my minor child/ward as listed below in this form (“My Child”), being allowed to participate in any way in this Detroit United Lacrosse program, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. The risk of injury to My Child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and2. I, for myself, my spouse, My Child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, Detroit United Lacrosse sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to My Child’s involvement or participation in this program, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and3. FOR MYSELF, MY SPOUSE, AND MY CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for My Child’s participation; and4. I, for myself, my spouse, My Child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to My Child’s involvement or participation in these programs, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted by law; and5. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in My Child’s readiness for participation and/or in the program itself, I will remove My Child from participation in the program and bring such to the attention of the nearest official immediately; and6. I grant Detroit United Lacrosse, and its trustees, advisors, staff, volunteers, agents, successors, licensees, and assigns, the irrevocable right and license to use videography, audio, and photography, to edit or crop photographs, and to use or authorize the use of such audio, videography, or photography or any portion of them in any manner or media at any time in perpetuity, and to use My Child’s name, likeness, biographical or other information concerning him/her in connection therewith, including promotion in all media. I agree to hold Detroit United Lacrosse harmless against any liability, loss, or damage resulting from the use of My Child’s photographs, and I hereby release and discharge Detroit United Lacrosse and its trustees, advisors, staff, volunteers, sponsors, agents, successors, licensees, and assigns from any and all claims in connection with such use of photographs; and7. If I am unable to provide transportation for My Child, I give permission for My Child to be driven by Detroit United Lacrosse and its staff and/or volunteers, including parents of participants. I assume full responsibility and I hold harmless Detroit United Lacrosse and its trustees, advisors, staff and volunteers from any and all claims related to such transportation.8. Detroit United Lacrosse and its partners offer surveys to youth and to parents. I consent for Detroit United Lacrosse to use survey information for the improvement of programs and for reporting aggregate information about programs, coaches, parents, and youth. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT., sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to My Child’s involvement or participation in this program, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and3. FOR MYSELF, MY SPOUSE, AND MY CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for My Child’s participation; and4. I, for myself, my spouse, My Child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to My Child’s involvement or participation in these programs, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted by law; and5. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in My Child’s readiness for participation and/or in the program itself, I will remove My Child from participation in the program and bring such to the attention of the nearest official immediately; and 6. If I am unable to provide transportation for My Child, I give permission for My Child to be driven by Detroit United Lacrosse and its staff and/or volunteers, including parents of participants. I assume full responsibility and I hold harmless Detroit United Lacrosse and its trustees, advisors, staff and volunteers from any and all claims related to such transportation. 7. Detroit United Lacrosse and its partners offer surveys to youth and to parents. I consent for Detroit United Lacrosse to use survey information for the improvement of programs and for reporting aggregate information about programs, coaches, parents, and youth. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Clear
Demographic Info & Participation Questions

As a non-profit organization, we use demographic data in order to get funding to keep our programs extremely low cost. Additionally, we want to make sure our programs are accessible to everyone - please fill out the information below! (Como organización sin fines de lucro, utilizamos datos demográficos para obtener fondos para mantener nuestros programas a un costo extremadamente bajo. Además, queremos asegurarnos de que nuestros programas sean accesibles para todos. ¡Complete la información a continuación!)
Race*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteBiracialPrefer not to answer
Are you of Hispanic or Latino/a origin? (¿Eres de origen hispano o latino/a?)*

YesNoPrefer not to answer
Do you qualify for free/reduced lunch? (¿Califica para almuerzo gratis oa precio reducido?)*

YesNoPrefer not to answer
Please provide information about any allergies or medical conditions that the coach should have in case of emergency. (Proporcione información sobre cualquier alergia o condición médica que el entrenador deba tener en caso de emergencia.) *
Does your child have any current conditions that limit his/her ability to participate in this activity? (¿Tiene su hijo alguna condición actual que limite su capacidad para participar en esta actividad?)*
If “yes”, please explain and identify any modification that would enable your child to participate. (En caso afirmativo, explique e identifique cualquier modificación que permitiría a su hijo participar.)
COVID Policy: The safety and health of campers and staff is always the highest priority at Detroit United's camps. With the spread of the coronavirus disease (COVID-19) within the United States, we ask you to please keep your child home if they are feeling ill. (Política de COVID: La seguridad y la salud de los campistas y el personal es siempre la máxima prioridad en los campamentos de Detroit United. Con la propagación de la enfermedad del coronavirus (COVID-19) dentro de los Estados Unidos, le pedimos que mantenga a su hijo en casa si se siente enfermo.)*

I understand
Refund policy. If an accepted registration is withdrawn for any reason up until 8 days prior to the start of the camp, you will receive a refund. No refund will be issued within one week of a camp session’s start date.*

I understand
Emergency Contact Information (name, cell phone number, relationship to child) (Información de contacto de emergencia (nombre, número de teléfono celular, relación con el niño))*
How did you hear about us? (social media/another organization/etc)*
Photo Release: I give permission for photos/videos to be taken of my child, and I understand that they may be used on organizational social media platforms or our Detroit United Lacrosse website. (Publicación de fotos: Doy permiso para que se tomen fotos/videos de mi hijo, y entiendo que pueden usarse en plataformas de redes sociales organizacionales o en nuestro sitio web de Detroit United Lacrosse.)*
Any additional notes?
My Products
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2023 Detroit City Recreational LacrosseCovers registration fee, practices, games, lacrosse stick, equipment rental, healthy snack
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