Spring 2012 Registration Form for Boys and Girls Grades K-8 by yaohongmeiyes

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									                PORT JEFF VILLAGE LACROSSE ASSOC.
                        SPRING 2012 REGISTRATION FORM FOR BOYS AND GIRLS GRADES K-8
              FEE PER PLAYER: $130.00 (IF YOU ALREADY HAVE A GAME JERSEY)
  $165 PER PLAYER (JERSEY INCLUDED) (FAMILY DISCOUNT OF $10.00 OFF EACH ADDITIONAL CHILD FOR
              EXAMPLE: 2ND CHILD = $155, 3RD CHILD $145, ETC.) EQUPIMENT REQUIRED
           ****INCLUDES FREE RAFFLE TO WIN FREE REGISTRATION****
________________________________________________________________________________________    __
  PLEASE COMPLETE THIS FORM, MAKE CHECKS PAYABLE TO “PORT JEFFERSON LACROSSE” AND SEND TO THE
                         ADDRESS BELOW NO LATER THAN DECEMBER 9TH , 2011

PORT JEFF LACROSSE IS SENITIVE TO THE ECONOMIC CLIMATE AND IF THERE IS A FINANCIAL HARDSHIP CASE WHERE A GIRL/BOY WOULD LIKE
TO PLAY AND CAN’T AFFORD THE FEE AND OR EQUIPMENT, THE SITUATION WILL BE REVIEWED BY THE BOARD AND A POSSIBLE WAIVER MAY BE
                                                         EXTENDED.
                                                CALL 631-903-7334 TO DISCUSS

                                                                                       TH
                                      WALK IN SIGN UPS DECEMBER 6 @ SCRAGGY HILL GYM HALLWAY 6:30-8PM
                                              PORT JEFFERSON VILLAGE LACROSSE ASSOCIATION, INC.
                                                     PO BOX 414, PORT JEFFERSON, NY 11777
                                                          WEBSITE : HTTP://PJLAX.COM/
              Any questions please contact Bill Scannell at portjefflax@gmail.com
__________________________________________________________________________________________
                        REGISTRATION / RELEASE OF LIABILITY                                                (Fill out one form per player)

       PLAYER’S LAST NAME: ____________________________________ FIRST NAME:_________________________________

       STREET ADDRESS: ______________________________________________________________________________________

       TOWN__________________________________________________________ ZIP CODE_______________________________

       HOME PHONE: _________________________ CELL/EMERGENCY PHONE: _______________________________________

       DATE OF BIRTH: _______________ GRADE 2011/2012 School Year:_______ New Player Y/N, if No years played ________

       PARENT’S NAMES:______________________________________                                    E-MAIL: _______________________________________

       Jersey Size: ____________ (Adult Small to Adult XL and Youth Small to Youth Large )

       1st choice /Jersey # __________                               2nd Choice ____________                         3rd Choice ______________
      Are you interested in getting involved in Port Jefferson Youth Lacrosse? If “yes”, then please check
      below:
      ___Team Parent ___Field Set Up ___Coach ___Fundraising Efforts ___ other (please describe below)
Please read the following information and regulations and agree to abide by them. I/We, the parent(s) of the above named candidate for a position on a Port Jefferson Lacrosse team,
hereby give my/our approval to participate in any and all Port Jefferson Lacrosse activities, including transportation to and from a game, jamboree, or tournament. I/We know that
participation in lacrosse may result in an injury. I/We do hereby waive, release, absolve, indemnify, and agree to hold harmless Port Jefferson Lacrosse, organizers, sponsors,
supervisors, participants, and person transporting my/our children to and from activities for any claim arising out of any injury to my/our children whether the result of negligence or
for any other cause, except to the extent and in the amount covered by accident or liability insurance. I/We agree to return upon request the uniform and other equipment issued to
my child in as good as a condition as when received. I/We will furnish a certified birth certificate of the above named candidate upon the request of Port Jefferson Lacrosse. I/We
give permission to Port Jefferson Lacrosse for me or my child to be photographed or videotaped during lacrosse game, practice or activities. I acknowledge that no compensation will
be paid by Port Jefferson Lacrosse or any third party to my child or me with respect to such use of my or my child’s images. I understand that these photographs or videotapes may be
used by Port Jefferson Lacrosse for promotional purposes, also without compensation by Port Jefferson Lacrosse or any third party.
                                                                                  Parents Code of Ethics
The Parents and Spectators shall uphold the honor and dignity of the game. In all contact with players, coaches, officials, and anyone else involved with the leagues shall strive to set
an example of the highest ethical and moral conduct. The parents and spectators shall respect and support contest officials and coaches. They shall not indulge in conduct, which
would interfere with the players, coaches, officials, or anyone else connected with the contest. There will be zero tolerance for any spectator that yells negatively at a player, coach, or
official. Any spectator that takes part in this behavior will be asked to leave the field area. And- if any parent/spectator enters onto a playing field, or in any way interferes with the
game, the players, or anyone affiliated with the league, including the officials, that individual, and their related player, will be asked to leave the school grounds and field area. This is
not to include an injury situation, unless an abusive or unsportsmanlike behavior initiates or is involved. The coaches will support and assist in the enforcement of this rule.
After contests, all players, parents, and spectators are expected to clean up any and all items brought to the field, including water bottles, sports bottles, etc.

PARENT / GUARDIAN SIGNATURE: __________________________________________ DATE: _______________

								
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