Player Name*
Graduation Year*	--Select-- 2013 2014 2015 2016
Position*	--Select-- A C M D G
Date of Birth*
School*
Grade*
Address*
Address Line 2*
City*
State*
Zip*
Email*
Parent's Name*
Parent's Phone*
U.S. Lacrosse Number*
Family Physician*
Medications*	Yes No
What Type?*
Insurance Company*
Policy Number*
Do you play other sports?*	Yes No
Which Ones?*
Waiver and Release *	As the parent and/or legal guardian of, I hereby waive and release Greene Turtle Lacrosse Club, Greene Turtle W.O.C., LLC, R., and any other employees or assistants of these entities, from any liability, including liability as a result of negligence, or an injury, accident or illness incurred while participating in Greene Turtle Lacrosse Club activities. I UNDERSTAND THAT THERE IS A RISK OF INJURY TO MY CHILD PLAYING COMPETITIVE LACROSSE AND KNOWINGLY AND VOLUNTARILY ASSUME ALL RISK OF SUCH INJURY OR ACCIDENTS. I will be financially responsible for any medical attention or cost of transportation needed in association with my child's participation with Greene Turtle Lacrosse Club, or resulting from an injury received while playing lacrosse or participating in activities. The medical insurance information provided on my child's Player Participation Form shall be the insurance coverage for any medical treatment. Agree