The Elite 150 - Summer-16

The Outback Steakhouse Summer-16 Invitational: Consent Form…”PLAY FOR THE STEAK”

Friday 7/23 to Sunday 7/25 @ Mount St. Mary’s University

Summer-16 Varsity Tournament @ Mount St. Mary's University

Please complete and send to:
(All team players must complete this form and return it to your coach or team organizer.)

Tom Gravante, Head Lacrosse Coach
Mount St. Mary’s University
16300 Old Emmitsburg Road
Emmitsburg, MD 21727

(O) 301.447.5356 | (C) 301.471.8206
(Fx) 301.447.6723

Name:	____________________________	Position:	A M D G (circle)
Address:	____________________________	Age/Grade:	________________________
	____________________________	Coach’s Name:	________________________
Home #	____________________________	Coach's Phone:	________________________
Cell #	____________________________	Coach's Email:	________________________
Email address:	____________________________	Team Name:	________________________
Parent’s cell#	____________________________

Parent/Guardian consent:

I hereby authorize the Elite 150, Inc. lacrosse tournaments/camps/clinics 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, Inc. lacrosse tournaments/camps/clinics, its staff, officers, representatives, employees, and successors from any and all rights and claims for damage to person and property while at the lacrosse site or any facilities or building(s) on the campus of Mount St. Mary’s University.

Parent/Guardian Signature___________________________________

Date________________

TOURNAMENT FEES: Commuter-$175/player, no meals. Day-$225/player; includes lunch and dinner. Resident-$275/player; includes single or double occupancy room and all meals. All team registration consent forms due by June 1st, 2010.