ALOHA YOUTH LACROSSE ASSOCIATION

Date: Sept 29, 2024

Time: 11:00 AM - 2:00 PM

Cost: $20

*New to Lacrosse? Enter code XTQ42 to receive free entry. ***For first time players only and this will be verified. 2 Free Clinics max per keiki

*All participants are required to arrive properly dressed and please bring a water bottle.

Athlete Information

Athlete's Name:*

First NameLast Name

Birth Date:*

MonthDayYear

Age on date of Clinic:*

Gender:*

MaleFemale

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of School participant attends:

Does participant need equipment/gear provided? (If yes, select all that apply below to ensure participant has everything he/she needs. If no, please disregard.):*

YesNo

Select all that apply for Male Participant:

Select all that apply for Female Participant:

GogglesStick

Has participant played Lacrosse before?*

YesNo

If yes, what position(s) does participant play?

Parent/Guardian Information

Name:*

First NameLast Name

Contact Number:*

Area CodePhone Number

E-mail:*

Address (if different from the player's):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Informed Consent and Acknowledgement

PARTICIPANT WAIVER

Please read carefully. By signing this document, you forfeit certain legal rights.

1.The undersigned (“Parent/Guardian”) Parent/Guardian certifies that Participant is in good physical condition and able to participate in sports training activities including, but not limited to, physical strain and exertion. Parent/Guardian certifies, further, that any and all information Parent/Guardian has provided to Aloha Youth Lacrosse Association is accurate and complete.

2.Parent/Guardian and Participant understands and agrees that there are risks involved in participating in any exercise and sports activities, whether as a coach, trainer, or player. Participant acknowledges that playing lacrosse naturally involves risk of injury to Participant and potentially others, whether caused by Participant or someone else. Participant agrees that to reduce the risk of injury, Participant shall comply with any and all safety rules of Aloha Youth Lacrosse Association. Participant is aware that neither Aloha Youth Lacrosse Association nor any instructor provides medical advice or treatment, or medical or any other kind of insurance, to participants.

3.Parent/Guardian and Participant understands and agrees that Aloha Youth Lacrosse will not be liable for any injury including, without initiation, personal, bodily or mental injury, economic loss or any damage to Participant, guests, parents, or other relatives, as applicable, resulting from participation in Aloha Youth Lacrosse Assocation Clinics. This limitation of liability applies to any and all (i) activities relating to field lacrosse and lacrosse training lessons, programs, games, practices, demonstrations, drills, turf-related activities, exercises required by coaches, (ii) accidents, break-ins, vandalism, theft, or other activities, in the parking lot or street parking.

4.Parent/Guardian certifies that Participant has adequate insurance coverage with respect to any and all possible losses, claims, injuries, liability, damage, or other insurable event that could occur in connection with Participant’s participation in any activities with Aloha Youth Lacrosse Association.

I HAVE READ AND FULLY UNDERSTAND ALL THE INFORMATION ABOVE.

Parent/Guardian Signature:*

Date

Confirmation

BY SIGNING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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2024-2025 AYLA CLINIC - Session 2 of 5 $20.00

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2024-2025 Lacrosse Clinic Series - Boys and Girls K-12 Clinic 2 of 5