Student Sports Registration Form

PERSHING PANDAS LACROSSE REGISTRATION

Thank you so much for registering to be a part of the Pandas Lacrosse Family!

We are a private, non-profit club, open to 5th-8th Graders from all area schools, backgrounds, and experience levels, that relies on a per-player contribution of $400 for the entire Fall/Spring season. This fee allows us to pay for our amazing coaches, our fields, gear and equipment, referees, and everything else that keeps our club running.

If you would like to pay by Credit Card, you may do so at the end of this form.
We can also accept Venmo, Paypal, or Cash.

If you would like to set up a payment plan, or are facing financial hardship -- your son WILL still play. Please reach out to me, and we'll make it work.
That's why we're here.

Program Manager - Travis Graf at 346-274-8490 or pershinglax@gmail.com.

This registration includes a Liability Waiver, which is required.
Player Information
Name

First NameLast Name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Grade
School
Address Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Information (if participant is under 18)
Parent or Legal Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Additional Contact Email
example@example.com
Emergency Contact 1

In the event of an emergency, please contact:
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Player
Emergency Contact 2

In the event of an emergency, please contact:
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Player
Shirt Size
Shorts Size
NUMER CHOICES (PICK 3, IN ORDER OF PREFERENCE)

PERMISSION TO PARTICIPATE AND WAIVER OF LIABILITY

YOUTH PARTICIPATION CONSENT, ACKNOWLEDGMENT OF RISKS, AND PARENT/GUARDIAN RELEASE

Program/season: PERSHING BOYS LACROSSE – FALL ’26 – SPRING ‘27
Coverage dates: 09/14/2026 through 05/31/2027

In this document, “Club” means Pershing Pandas Boys Lacrosse Team, operated by PERSHING PANDAS LACROSSE CLUB

“Club Activities” means Club-organized lacrosse practices, instruction, conditioning, games, tournaments, clinics, and team events occurring within the coverage dates above. Transportation is not authorized by this document and requires separate arrangements or permission.

1. Permission to Participate
I represent that I am the participant’s parent or legal guardian and have the authority to consent to participation. I voluntarily authorize the participant to take part in Club Activities, subject to applicable eligibility requirements and Club rules.
I understand that participation involves physical exertion and contact and that the Club cannot guarantee an injury-free experience.
INITIAL
2. Acknowledgment of Lacrosse Risks
I understand that lacrosse and related activities involve foreseeable and unforeseeable risks, including, but not limited to:
• Contact with players, sticks, balls, goals, and other equipment;
• Checking, collisions, falls, and being struck by a ball or stick;
• Cuts, bruises, sprains, and fractures;
• Concussions and other head, neck, spinal, or internal injuries;
• Uneven, wet, slippery, or otherwise hazardous playing surfaces;
• Equipment failure;
• Communicable illnesses; and
• Permanent disability, paralysis, or death.

Protective equipment, coaching, supervision, and rules greatly reduce these risks, but they do not eliminate them. I have considered these risks in deciding to permit participation and will discuss them with the participant in an age-appropriate manner.
This acknowledgment does not excuse unsafe conduct or eliminate the Club’s legal duties.
Initial
3. Health, Equipment, and Safety Responsibilities
I agree to:
(a) Provide accurate information about medical conditions, allergies, restrictions, and emergency contacts relevant to safe participation;
(b) Seek medical advice when there is a question about the participant’s ability to participate safely;
(c) Encourage prompt reporting of injuries, symptoms, unsafe conditions, bullying, and other safety concerns; and
(d) Follow Club rules concerning attendance, authorized pickup, conduct, and emergency procedures.
The participant must stop activity and notify a coach when injured, unwell, or experiencing possible concussion symptoms. A participant removed for a suspected concussion may return only after satisfying applicable medical clearance and return-to-play requirements.
Nothing in this section transfers the Club’s own safety responsibilities to the participant or parent.
Initial
4. Emergency Care Authorization
If I cannot be reached promptly, I authorize Club personnel to contact emergency services, arrange emergency transportation, and seek evaluation and treatment for the participant. To the extent I may legally consent, I authorize licensed healthcare professionals to provide medically necessary emergency care.
Reasonable efforts should be made to contact me, but emergency assistance need not be delayed while those efforts occur.
This authorization does not appoint coaches or volunteers as medical professionals or authorize routine medication administration. Any medication assistance requires separate written arrangements.
I understand that medical and ambulance charges may be billed to me or the participant’s insurer, subject to applicable law. This provision does not release any person from liability for those costs.
Initial
6. RELEASE OF THE SIGNING ADULT’S OWN CLAIMS — INCLUDING ORDINARY NEGLIGENCE
IN CONSIDERATION OF THE CLUB PERMITTING THE PARTICIPANT TO TAKE PART IN CLUB ACTIVITIES, I, IN MY INDIVIDUAL CAPACITY ONLY, RELEASE THE CLUB AND ITS DIRECTORS, OFFICERS, EMPLOYEES, COACHES, AND AUTHORIZED VOLUNTEERS (“RELEASED PARTIES”) FROM CLAIMS THAT I PERSONALLY OWN AND MAY LAWFULLY RELEASE ARISING FROM THE PARTICIPANT’S INVOLVEMENT IN CLUB ACTIVITIES DURING THE COVERAGE DATES.
THIS RELEASE EXPRESSLY INCLUDES MY OWN CLAIMS CAUSED IN WHOLE OR IN PART BY A RELEASED PARTY’S ORDINARY NEGLIGENCE, INCLUDING ORDINARY NEGLIGENCE IN COACHING, INSTRUCTION, SUPERVISION, EQUIPMENT SELECTION OR INSPECTION, OR THE SELECTION OR INSPECTION OF ACTIVITY LOCATIONS. IT APPLIES WHETHER THAT ORDINARY NEGLIGENCE ACTS ALONE OR TOGETHER WITH ANOTHER CAUSE.
THIS RELEASE DOES NOT COVER GROSS NEGLIGENCE, RECKLESSNESS, INTENTIONAL MISCONDUCT, ABUSE, OR ANY CLAIM OR LIABILITY THAT APPLICABLE LAW DOES NOT PERMIT TO BE RELEASED.
I DO NOT PURPORT TO RELEASE THE MINOR PARTICIPANT’S OWN CLAIMS. I DO NOT AGREE TO INDEMNIFY THE RELEASED PARTIES OR PAY THEIR DEFENSE COSTS IF THE PARTICIPANT OR ANOTHER PERSON BRINGS A CLAIM.
Initial
7. Medical Information
RELEVANT ALLERGIES, CONDITIONS, RESTRICTIONS, OR INSTRUCTIONS - or "None"
HEALTH INSURER, IF ANY
Relevant medical information may be shared with personnel who reasonably need it for participant safety or emergency care, subject to applicable law.

8. Scope and Interpretation
This document applies only to the identified participant, Club Activities, and coverage dates. It does not grant photography or publicity permission.
Texas law governs to the extent applicable. If a provision is unenforceable, the remaining provisions shall remain effective to the extent permitted by law. No provision shall be interpreted to release a claim that cannot lawfully be released.

9. Parent/Guardian Agreement
I have read this document, understand the risks described, and have had an opportunity to ask questions. I understand that Section 6 releases certain claims belonging to me personally, including claims based on ordinary negligence, subject to its stated limitations.
Signature

If you wish to pay by Credit Card you may check the box and use this service. If you would like to use an alternative method, or would like to discuss alternative arrangements, please just hit "submit" without checking the box and we can discuss.
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Registration and Uniforms
Covers coaching, uniforms, fields, referees and gear for the season. Payment plans are available if needed. Reach out to pershinglax@gmail.com with questions.

$400.00

Total

$0.00
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