2025 Bearcats of the Bluegrass Player Registration

Player's Name*

First NameLast Name

Players Cell Number*

Please enter a valid phone number.

Player's Primary Position.*

Player's Secondary Position.*

How did you hear about us or who referred you.*

We want to know who to thank or what's helping us grow.

Player's School

Current Middle or High School

Current Grade*

Last grade completed, if summertime.

Graduation Year*

Date of Birth*

USA Lacrosse Member #

USA Lacrosse Membership Expiration Date

Player's Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian's Name*

First NameLast Name

Parent/Guardian's Phone Number

Please enter a valid phone number.

Parent/Guardian's Email*

example@example.com

Name of Player's Doctor

First Name or Dr.Last Name

List any Medical Conditions or Allergies

Only need to list items that our coaching staff needs to watch for.

Health Insurance Carrier *

Health Insurance ID#*

Name of Emergency Contact*

First NameLast Name

Phone Number of Emergency Contact*

Please enter a valid phone number.

GENERAL LIABILITY RELEASE AND WAIVER OF CLAIM

IN CONSIDERATION OF the permission granted my child (whom I have identified above) by the Bearcats National to participate in its Lacrosse Programs, Activities and Leagues, I HEREBY WAIVE any and all claims or causes of action against the Bearcats National, its volunteers, agents, assigns, board members and officers (hereinafter collectively referred to as the “Bearcats National”) which I and/or my child may have against the Bearcats National, and HEREBY RELEASE AND HOLD HARMLESS the Bearcats National from any and all claims, demands, cause of action, judgments, and executions which I and/or my child ever had, or now have, or which my or my child’s heirs, executors, administrators, or assigns, may have, or claim to have, against the Bearcats National for all personal injuries or death, known or unknown, and injuries to property, real or personal, or for any other consequential or incidental damages caused by or arising out of the programs, activities or leagues sponsored and administered by the Bearcats National where any such liability is or may be attributable to the alleged negligence (absence of
ordinary care) of the Bearcats National.

I verify that my child is or will be a USA Lacrosse member in good standings and that my child's membership will be valid and not past the expiration date when participating in Bearcats National activities.

I verify that my child has a current and valid Athletic Participation/Physical Examination Form stating my child is physically fit to play Lacrosse without restrictions and will provide a copy to the Bearcats National.

I authorize the Bearcats National to seek, provide and/or administer medical attention for my child should they be injured and/or have any medical condition warranting such action while in the care of the Bearcats National and accept financial liability for any such care.

I, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE, AND AGREE THAT THIS RELEASE AND WAIVER SHALL BE LEGALLY BINDING ON ME, MY CHILD AND OUR HEIRS, BENEFICIARIES, ASSIGNS OR ANY OTHER SUCCESSORS IN INTEREST.

Bearcats National
Student Media Release Form

I, as the parent/guardian of the above named minor child, hereby give Bearcats National and its employees, representatives and authorized media organizations permission to photograph, interview and record my child and his/her likeness for use in audio, video, film or other electronic, digital and printed media. I also give Bearcats National permission to release photos or recordings of any type to any media outlets including, but not limited to, team social media, YouTube, newspapers and television stations. I understand that neither Bearcats National nor the media outlet has any obligation to use or be compensated for such rights. I am also aware that I will not receive monetary compensation for my child’s participation, and I waive any right to inspect or approve final use of materials. I agree to release and hold harmless Bearcats National, its staff, and assignees from any liability or claims of damage, known or unknown, related to such use.

Additionally, this consent is valid as long as the child participates on one of the teams. If at any time youwish to withdraw your consent, you may contact Bearcats National at 502-216-3453; however, any prior photos or recordings of your child will remain part of the Bearcats National archive.

I, the Parent/Guardian, of the above named minor child has read and agrees to the General liability Release, Waiver of Claim and Student Media Release. It is also agreed that if the Payment Plan option is chosen below, that the card used to pay the deposit will be charged the monthly payment amount listed below for the next 4 months. *

Player Fees*

BoB Summer Middle School TeamPlayers cost includes all practices (total of 15), the tournament fees and a pinnie to keep. Players need to have their own stick, gear and helmet. Bearcats of the Bluegrass Summer Middle School Team will participate in the following 3 tournaments: Southeast Shootout in Gatlinburg TN. June 14-15, The Grail in Westport IN. June 28-29, Seaside Showdown in Virginia Beach VA. July 26-27.

$869.00

BoB Summer Middle School Team Payment PlanTHE $269 DEPOSIT WILL BE CHARGED TODAY AND $150 WILL BE CHARGED TO THE CARD ON FILE FOR THE NEXT 4 MONTHS TO COMPLETE THE PLAYER REGISTRATION FEE. Players cost includes all practices (total of 15), the tournament fees and a pinnie to keep. Players need to have their own stick, gear and helmet. Bearcats of the Bluegrass Summer Middle School Team will participate in the following 3 tournaments: Southeast Shootout in Gatlinburg TN. June 14-15, The Grail in Westport IN. June 28-29, Seaside Showdown in Virginia Beach VA. July 26-27.

$269.00 Quantity

BoB Fall Middle School Team Players cost includes all practices (total of 10), the tournament fees and a pinnie to keep. Players need to have their own stick, gear and helmet.Bearcats of the Bluegrass Fall Team will participate in the following tournaments:Music City Mayhem in Nashville TN the 1st weekend of November,Carolina Fall Classic in Columbia SC the 3rd weekend in November.

$669.00 Quantity

BoB Fall Middle School Team Payment PlanTHE $269 DEPOSIT WILL BE CHARGED TODAY AND $100 WILL BE CHARGED TO THE CARD ON FILE FOR THE NEXT 4 MONTHS TO COMPLETE THE PLAYER REGISTRATION FEE. Players cost includes all practices (total of 10), the tournament fees and a pinnie to keep. Players need to have their own stick, gear and helmet.Bearcats of the Bluegrass Fall Team will participate in the following tournaments:Music City Mayhem in Nashville TN the 1st weekend of November,Carolina Fall Classic in Columbia SC the 3rd weekend in November.

$269.00 Quantity

PinniePlayers get to keep their pinnie, please LIST YOUR SIZE here.

$ Free Youth SizeAdult Size

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Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

For additional information and complete list of terms & conditions, go to www.bearcatsnational.com, email coach@lacrossebearcats.com or call/text Coach Jeff at 502-216-3453.

Bearcats National will not sell or distribute any information provided except as required by a tournament group and/or USA Lacrosse for registration or verification.

Requests for refunds for individually purchased tournaments and Pick 4 or Pick 6 more than 90 days prior to the tournament date or first tournament chosen date for Pick 4/6, must be by email. Refund will be subject to a 20% handling fee and no refund will be issued on any fees, and/or taxes. Requests made between 31 to 90 days prior to the tournament date or first tournament date for Pick 4/6 must be by email. Refund will be subject to a 50% handling fee. There will be no refund for requests 30 days or less prior to the tournament.

Upon players participation in a tournament this purchase is non-refundable. Player may substitute or change desired tournaments to participate in during 2024. Only a 1 tournament credit will roll over into 2025.

Players who are injured and cannot participate in a tournament may transfer their registration to another tournament when request or notification is made at least 15 days prior to the tournament date. Any request for a refund will follow our general refund policy. If a player is unable to return to play for the remainer of the calendar year, the tournament credit will roll over to the next year. However, player will be responsible for any increase in the cost to participate in a tournament.

Payments will appear on your credit card statement as Jett Fast Hauling LLC.