2024 LAX Registration Form

Registration Form
Select Number of Registrants in Family:*
Select Session:*
Parent Name*

First NameLast Name
Phone:*
Please enter a valid phone number.
Cell Phone:*
Please enter a valid phone number.
E-mail is the primary method of communication the Gamber Lacrosse program will use to notify you of news and events. Please be sure to enter a valid and correct e mail address that you check at least once a week so you are always up-to-date with the latest lacrosse news.
Email Address:*
example@example.com
Confirm Email Address:*
example@example.com
If you have any additional e-mail addresses where you would like to receive updates, please enter them here.
Email Address (Second):
example@example.com
Email Address (Third):
example@example.com
PARTICIPANT DETAILS
1. PLAYER INFORMATION
Name*

First NameLast Name
Gender:*
Birth Date:*

MonthDayYear
Date
Current School:*
Current Grade:*
League:*
This Players Cost:
Prev Years Exp:*
Preferred Position:*
UNIFORM INFORMATION
Jersey Size:*
VOLUNTEER INFORMATION
Parent would like to volunteer for:*
Name of Parent Volunteering:
MEDICAL INFORMATION
Does your child have any special medical or behavioral problems?*
Medical/Behavioral Factors:
Explain:
2. PLAYER INFORMATION
Name*

First NameLast Name
Gender:*
Birth Date:*

MonthDayYear
Date
Current School:*
Current Grade:*
League:*
This Players Cost:
Prev Years Exp:*
Preferred Position:*
UNIFORM INFORMATION
Jersey Size:*
VOLUNTEER INFORMATION
Parent would like to volunteer for:*
Name of Parent Volunteering:
MEDICAL INFORMATION
Does your child have any special medical or behavioral problems?*
Medical/Behavioral Factors:
Explain:
3. PLAYER INFORMATION
Name*

First NameLast Name
Gender:*
Birth Date:*

MonthDayYear
Date
Current School:*
Current Grade:*
League:*
This Players Cost:
Prev Years Exp:*
Preferred Position:*
UNIFORM INFORMATION
Jersey Size:*
VOLUNTEER INFORMATION
Parent would like to volunteer for:*
Name of Parent Volunteering:
MEDICAL INFORMATION
Does your child have any special medical or behavioral problems?*
Medical/Behavioral Factors:
Explain:
4. PLAYER INFORMATION
Name*

First NameLast Name
Gender:*
Birth Date:*

MonthDayYear
Date
Current School:*
Current Grade:*
League:*
This Players Cost:
Prev Years Exp:*
Preferred Position:*
UNIFORM INFORMATION
Jersey Size:*
VOLUNTEER INFORMATION
Parent would like to volunteer for:*
Name of Parent Volunteering:
MEDICAL INFORMATION
Does your child have any special medical or behavioral problems?*
Medical/Behavioral Factors:
Explain:
Family Details
Address 1:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address 2:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Emergency Contact*
Phone Number:*
Please enter a valid phone number.
Non-Residential Parental Contact (If Applicable)
Name

First NameLast Name
Home Phone:
Please enter a valid phone number.
Home Phone:
Please enter a valid phone number.
Email Address:
Address 1:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsorship
Are you (or do you know anyone) interested in sponsoring a lacrosse team? If yes, please provide their information and we will contact them directly.
First Name:
Last Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.
E-mail Address:
Donations:
Please consider an additional donation to the Gamber Lacrosse Program. Any additional contributions are used for equipment, uniforms or any additional expenses incurred by the program. We thank you for your support. (If you would like to contribute more than is available in the drop-down below, please contact Gamber Lacrosse via e-mail at gamberlax@gmail.com.)

Please note, any contribution will be associated with the first child's registration (if more than one child is registered).
Donation:
Agreements
The bylaws of Gamber Smallwood Lacrosse program require players to make a commitment to the Lacrosse program by being present for practices and games. Coaches reserve the right to restrict playing time if players have schedule conflicts due to other recreational activities, etc.

Please evaluate whether you and your player can make this commitment prior to registering. The bylaws of Maryland Youth Lacrosse Association (MYLA) restrict players to registering with ONE program only. Anyone violating this will be suspended from all MYLA sponsored activities.

My Child(ren) has my permission to participate in the Gamber Smallwood Optimist Lacrosse program at the time and places announced. The undersigned acknowledges that the Optimist Club or the Recreation Council does not provide any registrant medical or hospitalization insurance whatsoever and hereby waives any and all claims against the Optimist Club, Recreation Council and the Department of Recreation and Parks or any person affiliated with the Optimist Club or Recreation Council Program for injuries sustained while participating in any leisure games or traveling to and from games or participation in any leisure time activity. I/We assume responsibility for care of all equipment and uniforms loaned to the registrant and will return them to the Gamber Smallwood Optimist Club when requested or, in Lieu of the return of the equipment and uniform will pay the sponsor $200.00. I acknowledge reading and agreeing to information on this form.
*

I Agree:
CONCUSSION RELEASE FORM
I acknowledge I have read the concussion release form and agree to abide by its contents: Concussion Release Form
*

I Agree:
Maryland Youth Lacrosse Association has a participation contract for all players, parents and program volunteers. The Gamber Smallwood Lacrosse Program agrees to support this contract for the safety of all who participate with our organization. We require the following pledge to be agreed by the parents and players in order to process your registration.

Maryland Youth Lacrosse Association Participation Contract

I wish to participate in the Maryland Youth Lacrosse Association for the 2023 season. As a participant, I Pledge to:
1. Learn the rules of lacrosse so that I may be a better player, coach and fan.
2. Encourage good sportsmanship by demonstrating only positive support for all players, coaches and Officials at every event.
3. Support the drug and tobacco-free environment that is important for all youth sporting events.
4. Make supportive comments to all players, coaches, and officials.
5. Remember the field is a classroom and everyone is learning.
6. Focus on the fun and the participation.
7. Be prepared for each event by having the necessary papers.
I also pledge NOT to:
1. Ever use profanity at a youth event.
2. Criticize the coaches, players or officials.
3. Touch an opposing player, coach or game official in a threatening manner.
This contract must be signed by any player, parent or coach who wishes to participate in any MYLA event. The signature indicates that the person has read and agreed to the above mentioned items, and knows that the consequences, of violating one of these rules either by commission or omission, is ejection from the event. The Board will be notified of the ejection and consequences dictate that the one ejected must appear in front of the Board of the MYLA to
*

I Agree - Parent:
*

I Agree -Participants:
PHOTOGRAPH POLICY
Authorization for Use of Photographic Likeness: I agree to allow Carroll County Recreation and Parks to take and utilize photographic images of the registeredindividual's for the purpose of promotion and publicizing of the Department programs and/or events. If I prefer to not allow the above registered participant/s to be photographed, I will call 410-386-2103 to register my request.
*

I Agree:
CARROLL COUNTY DEPARTMENT OF RECREATION AND PARKS WAIVER AND RELEASE – COVID-19
COVID-19 Information

I, on behalf of my child(ren) or myself, acknowledge and understand that the novel COVID-19 virus is an extremely contagious virus and is believed to be spread mainly from person to person contact and that the Carroll County Government does not warrant or guarantee that you, your child(ren), your spouse, or anyone else will not be exposed to or infected with the COVID-19 virus as a result of my or my child(ren)s participation in the Program. I have independently evaluated the risks of being exposed to or infected by the COVID-19 virus and have determined to participate or allow my child(ren) to participate in the Program. Finally, understanding those risks, I, for myself, my child(ren), my spouse, or legal representatives, heirs, and assigns, hereby agree to assume full responsibility and liability for the risk of bodily injury, illness, permanent disability, and/or death which may result from exposure to or infection with COVID19 before, during, and after participating in the Program. Due to the strenuous nature of some activities, the participant, or if the participant is a child, the child(ren)s parent or guardian is encouraged to consult with a physician concerning the participants fitness to participate in the Program.
*

I Agree:
Payment Information
Total Amount Due:
Automatic $10 Per Player Donation Fee:
Billing Address
Address 1:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registration Policy
Please acknowledge the agreements below before finalizing your registration.
*

I agree to allow Gamber Lacrosse to share my submitted details with this program.By clicking Register below, I acknowledge the Gamber Lacrosse Terms of Service and Privacy Policy, as well as the terms below
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PLEASE TAKE NOTE...THE LAST BOX ABOVE THAT SHOWS 12345 IS ACTUALLY FOR YOUR CREDIT CARDS BILLING ZIP CODE...STRIPE IS TRYING TO RESOLVE THIS ISSUE BUT FOR NOW IF YOU PUT IN THE ZIP CODE OF YOUR CARD IT WILL PROCESS FINE. THANKS FOR YOUR PATIENCE!
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Registration Form

PARTICIPANT DETAILS

1. PLAYER INFORMATION

UNIFORM INFORMATION

VOLUNTEER INFORMATION

MEDICAL INFORMATION

2. PLAYER INFORMATION

UNIFORM INFORMATION

VOLUNTEER INFORMATION

MEDICAL INFORMATION

3. PLAYER INFORMATION

UNIFORM INFORMATION

VOLUNTEER INFORMATION

MEDICAL INFORMATION

4. PLAYER INFORMATION

UNIFORM INFORMATION

VOLUNTEER INFORMATION

MEDICAL INFORMATION

Family Details

Emergency Contact

Non-Residential Parental Contact (If Applicable)

Sponsorship

Donations:

Agreements

CONCUSSION RELEASE FORM

PHOTOGRAPH POLICY

CARROLL COUNTY DEPARTMENT OF RECREATION AND PARKS WAIVER AND RELEASE – COVID-19

Payment Information

Billing Address

Registration Policy

PLEASE TAKE NOTE...THE LAST BOX ABOVE THAT SHOWS 12345 IS ACTUALLY FOR YOUR CREDIT CARDS BILLING ZIP CODE...STRIPE IS TRYING TO RESOLVE THIS ISSUE BUT FOR NOW IF YOU PUT IN THE ZIP CODE OF YOUR CARD IT WILL PROCESS FINE. THANKS FOR YOUR PATIENCE!