The Outback Steakhouse-Elite 150 10 vs 10 Lacrosse Shootout
@ Mount Saint Mary's University
Please fill out and return to:
(All players must complete this form and return it to your coach/organizer.)
Tom Gravante, Head Lacrosse Coach
Mount Saint Mary’s University
16300 Old Emmitsburg Rd.
Emmitsburg, MD 21727
| Name: |
____________________________ |
Position: |
A M D G (circle) |
| Address: |
____________________________ |
Grade: |
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| |
____________________________ |
Coach’s Name: |
________________________ |
| Phone: |
____________________________ |
Coach's Phone: |
________________________ |
| Email address: |
____________________________ |
Coach's Email: |
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| Team Name: |
____________________________ |
Team Division |
A or B (circle) |
Parent/Guardian consent:
I hereby authorize the Elite 150 Lacrosse Camp to act on my behalf according to their best ability in any medical emergency. I verify to the best of my knowledge that the above named applicant is physically able to participate in all lacrosse activities. I, parent/guardian of the above lacrosse player, certify that he is covered by medical/health insurance, and has no chronic ailment or recurrent injury, which might endanger his well-being while participating in lacrosse activities/games. I further understand that lacrosse is a contact sport. As a participant in a contact sport, the player above accepts a certain responsibility to play in a sportsmanlike manner and for the normal, inherent risk of athletic injury. I, the undersigned, waive and forever discharge Mount St. Mary’s University, Tom Gravante, and The Elite 150 Lacrosse Camp, its staff, officers, representatives, employees, and successors from any and all rights and claims for damage to person and property while at this lacrosse site.
Parent/Guardian Signature___________________________________
Date________________
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