2021 Little Rhody Fall 100 Registration

2021 LITTLE RHODY FALL 100 - REGISTRATION & PAYMENT

* Indicates required field

Participant Name *

First

Last

Position *

Dominant Hand *

High School *

Class Year (Fall '21) *

Player E-mail *

Player Cell Number (for Text Alerts) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent(s) Name *

Parent E-mail *

High School Coach *

High School Coach E-mail *

Club Team (if applicable) *

Club Coach *

Club Coach E-Mail *

Insurance Carrier *

Insurance Policy Number *

Participant Health Issues *

Emergency Contact *

Emergency Contact Phone *

LIABILITY WAIVER
I represent that I am the parent and/or legal guardian of the child named below and hereby give my permission for my child to participate in any and all activities at the 2021 Little Rhody Fall 100 Showcase "Showcase" at Roger Williams University "University".

I agree to assume all risks associated with my child's participation in the Showcase including but not limited to, risk of bodily injury, sickness (including COVID-related illness), death, and / or property damage. In consideration of my child being permitted to participate in the Showcase, I agree to release, indemnify, and hold harmless the University & Little Rhody Lacrosse, LLC, its trustees, directors, officers, employees, students, contractors, volunteers, affiliates, and agents, from any and all claims that I or any third party might have as a result of my child's participation in the Showcase.

I understand that, per Roger Williams University policy at this time, participants who are not vaccinated for COVID-19 will be required to wear a mask at all times while on campus, including during participation in games.

I give my consent for my child to receive emergency medical treatment in the event that my child becomes ill or is involved in an accident during the Showcase. I understand that I will be notified at the emergency telephone number provided on this form in the event of an emergency involving my child.

Waiver Approved By *

Payment Option *

Credit Card Venmo

By clicking SUBMIT button below, your registration information will be submitted and you will be directed to different page for payment instructions.

Payment can be made via credit card (Visa, MasterCard, American Express or Discover) or by Venmo @rwumenslacrosse.

Please note that spot in Showcase is not guaranteed until payment has been received.

SUBMIT