Saint Stephen'S Lacrosse Application Form

SAINT STEPHEN’S LACROSSE APPLICATION
FORM
DUE BY NOVEMBER 1, 2009
Submit application (3 pages) with check:
1). Hand deliver or
2). Mail to 1311 Riverview Circle, Bradenton, FL 34209
Membership to U.S. Lacrosse is required to play for Saint Stephen’s

Lacrosse. Dues for U.S. Lacrosse are paid separately by each player to
U.S Lacrosse. Player must provide a copy of their current membership
card confirming a valid membership.
Join at www.lacrosse.org/membership
Our Group is Saint Stephen’s Lacrosse—ID #2551634
APPLICATION DUES:
2010 annual dues for Saint Stephen’s Lacrosse are:
• $200.00 Includes uniform, practice jersey and some travel fees
• Please make check payable to: Saint Stephen’s Lacrosse Club
• Check must accompany registration form
• All varsity players must have a white shell helmet (suggested for all
PLAYER INFORMATION: Date App Rcd._____________
PLAYER NAME:______________________________ US LAX #:_______________

EXP DATE:_______________
Date of Birth:____________ Age:__________ Grade:_________________
Previous Experience:___________________________ Position(s):________________
Primary Email:_______________________________________________________
Secondary Email:____________________________________________________
Primary cell phone:______________________Secondary:_______________________
Home Address:____________________________________________________________
City:____________________________ State:_______ Zip:___________________

Health Insurance Information:
Group Name:_______________________________________________
Insured’s Name:_____________________________________________
Policy Number::_____________________________________________
List any special medical conditions or restrictions:
_______________________________________________________________________
_______________________________________________________________________
Consent to participate and to allow Medical treatment:
I hereby consent to my child’s participation with the Saint Stephen’s Lacrosse Club. I consent and grant
permission to the club’s coaches and officials to obtain any necessary medical care as a result of injury
sustained by me child during participation in any club activity.
Amateur Athletic Waiver and Release of Liability and Understanding Relative to Participation:
In consideration of my child’s being allowed to participate in the Club’s activities, the undersigned parent
(s) or Legal Guardian(s):
1. Agree to instruct the minor participant prior to participating, he/she should inspect the facilities and
the equipment to be used, and if he/she believes that anything is unsafe, to immediately advise his/her
coach of such conditions and refuse to participate.
2. Acknowledge and fully understand that each participant engaging in activities that involve risk of
injury, including permanent disability and death, and severe social and economic losses may result
not only from their own action, inaction, or negligence, but action, inaction or negligence of others,
the rules of play, or condition of the premises or any equipment used. Further that there may be other
risks not known or reasonably foreseen at this time.
3. Assume all of the above risks and accept full personal responsibility for the damages following any
such injury, permanent disability or death.
4. Release, waive, discharge, and promise not to sue or otherwise agree to hold Club coaches, officers,
volunteers, other participants or others associated with the club and the owners/lesser of premises
used to conduct the events for any and all liability for injuries, damages, or death sustained by my
child during my child’s participation in any aspect of this activity.
5. Agree that my child’s participation in the Saint Stephen’s Lacrosse Club shall be subject to the poli-
cies and rules adopted from time to time by the Club, as well as the US Lacrosse Youth Council Code
of Conduct, a copy of which has been made available to me and I have read in conjunction with this
registration form.
6. Acknowledge that as a condition of my child’s participation in Club activities, my child is required to
join the US Lacrosse Organization. Revocation, cancellation or termination of my child’s member-
ship in US Lacrosse will result in my child’s immediate ineligibility to participate in any event spon-
sored by the Club.
7. Acknowledge that my child and I are responsible for the purchase of all protective and other equip-
ment necessary for my child’s participation, including without limitation, and as applicable lacrosse
helmet, shoulder pads, gloves, mouth piece, athletic cup, and shoes, and a throat guard and chest pro-
tector for goalies. Club coaches, officials, sponsors or volunteers shall have no liability or responsi-
bility for the condition of any equipment used by my child or any defect with respect thereto or as the
result of any injury damage disability or death arising there from.
I/we have read the foregoing provisions and acknowledge that I am freely and voluntarily agreeing to all
of the foregoing provisions, including without limitation those relating to release and waiver of liability.
Parent/Guardian Signature:
___________________________ ________ ________________________ _________

Signature Date Signature Date
Code of Conduct
Player, coaches, spectators and parents are to conduct themselves
in a manner that “Honors the Game” and demonstrates respect to other players,
coaches, officials and spectators. In becoming a member of the lacrosse commu-
nity an individual assumes certain obligations and responsibilities to the game of
lacrosse and its participants. The essential elements in this “Code of Contact” are
HONESTY and INTEGRITY. Those who conduct themselves in a manner that re-
flects these elements will bring credit to the sport of lacrosse, themselves, their
team and their organization. It is only through such conduct that our sport can
earn and maintain a positive image and make its full contribution to youth sports in
the United States and around the world. US Lacrosse and its Youth Council sup-
port the following behaviors for those participating or involved in in any way with
US Lacrosse and youth lacrosse in general:
• The essential elements of the “Code of Conduct” must be adhered to.
• Sportsmanship and teaching the concepts of fair play are essential to the
game, and must be taught and developed both at home and on the field during
practices and games.
• The emphasis on winning should never be placed above the value of good
sportsmanship, the concepts of fair play, or the skills of the game.
• Derogatory comment are unacceptable. Use positive reinforcement with play-
ers and adults alike. It should be remembered that criticism, once made, can
never be retracted.
• The safety and welfare of the players are of primary importance.
• Officials are expected to conduct themselves as professionals and in a manner
that demonstrates courtesy and fairness to all parties while exercising their au-
thority on the field.
• Adults involved with the must never permit anyone to openly or maliciously
criticize, badger, harass, or threaten an official.
• Knowledge of the Rules of Lacrosse must be respected and adhered to by all
who participate in the game of lacrosse, both in the letter and the spirit of the
game. Attempts to manipulate rules in an effort to take unfair advantage of an
opponent, or to teach deliberate unsportsmanlike conduct, is considered unac-
ceptable conduct.
• Coaches must always be aware of the tremendous influence they have on their
players. They are to strive to be positive role models in dealing with young peo-
ple, as well as with adults.
• Eligibility requirements, such as age and previous level of participation, must
be followed. They have been established to encourage and maximize participa-
tion, as well as promote safety.
Player and Parent/Guardian Signature
Player___________________________ Date__________________
Guardian________________________ Date__________________

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SAINT STEPHEN’S LACROSSE APPLICATION

Membership to U.S. Lacrosse is required to play for Saint Stephen’s

PLAYER INFORMATION: Date App Rcd._____________

PLAYER NAME:________________ US LAX #:_

Previous Experience:___________ Position(s):

Primary cell phone:Secondary:_

City:________________________ State:_ Zip:_________________

Consent to participate and to allow Medical treatment:

___________ _

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