LITTLE RHODY LACROSSE
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Quaker Lacrosse Showcase Registration
Guilford
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HINGHAM - 2018 LITTLE RHODY FALL 100 - REGISTRATION
*
Indicates required field
Participant Name
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First
Last
Position
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Attack
Midfield
Face-Off
LSM
LSM/D
Defense
Goal
High School
*
Class Year (Fall '18)
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2019
2020
2021
Other
Hingham Jersey Number
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Player Email
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Player Contact Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Parent(s) Name
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Parent Email
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E-mail address to be used for all correspondence for 2015 Little Rhody Summer 100 (in addition to player's e-mail address)
Insurance Carrier
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Insurance Policy Number
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Participant Health Issues
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Emergency Contact
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Emergency Contact Phone
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LIABILITY WAIVER
I represent that I am the parent and/or legal guardian of the participant named above and hereby give my permission for my child to participate in any and all activities at the 2018 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, 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 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
*
Must be approved by parent or guardian of participant if under 18 years of age
SUBMIT
HOME
Quaker Lacrosse Showcase Registration
Guilford
Staff & Contact