Little Rhody Lacrosse
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2018 LITTLE RHODY SUMMER 100 - REGISTRATION & PAYMENT
Indicates required field
Class Year (Fall '18)
Player Contact Number
E-mail address to be used for all correspondence for 2015 Little Rhody Summer 100 (in addition to player's e-mail address)
High School Coach
High School Coach E-mail
Club Team (if applicable)
Club Coach E-Mail
Insurance Policy Number
Participant Health Issues
Emergency Contact Phone
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 2018 Little Rhody Summer 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
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 check.
Please note that spot in Showcase is not guaranteed until payment has been received.