Registration-
Please type in information, print out,
sign at bottom, and mail with your check payable to Stephanie Cone,
364 Highland Drive, Seattle, WA 98109. Thank you. Team size limited
to 25, Queen Anne residents given priority.
Registration due
Feb. 8.
Player Name:
School:
Grade:
Home Phone:
Address:
Player Email:
Parent Email:
Fee $110.00 Amount paid:Check no.
Required for child to participate in
event. Parents please review and sign below.
Liability/Injury Waiver and Release
Player Name:
Does your child currently have medical
insurance:
Emergency Contact:
Emergency Day Phone:
Participation in athletic activities involves
the potential of minor to serious injuries to participants. Please
carefully consider the potential danger and risks associated with
athletic participation before you or your child decides to
participate on the Queen Anne Quick Styx Lacrosse Team. I hereby
acknowledge that participation in lacrosse including practices and
drills and related activities may result in injury to the
participant. I understand that neither the organizers, coaches,
individuals or anyone connected to the Queen Anne Quick Styx
Lacrosse Team will assume any medical, dental or other expenses
incurred as a result of any injury, and I release any organizers,
coaches, individuals or anyone connected to the Queen Anne Quick
Styx Lacrosse Team, from any and all claims and liabilities of any
nature arising from the participation on the Queen Anne Quick Styx
Lacrosse Team. I hereby authorize the coaches and assistants to act
on my behalf according to their best judgment in emergencies
requiring medical attention.
Parental signature is required for child
to participate.
