JSSLL 2010 Boys High School League Application Name ___________________________Position(s)_____ DOB___/___/___ Address______________________ City_______ State ____ZIP________ Phone (Home)_______________Work ___________Fax_______________ Email _______________________________________________________ School_______________________________ US Lacrosse #_______________________ _____________________________________________________________ League site: The National Guard Training Center, Sea Girt, NJ Registration:1. By mail or phone 732 330-2659 or Sundays June 6, 13, 20 11am – 2pm or opening day at 5pm League Fee: ____ $125.00 Individual ____Team $2000.00 (Attach minimum 20 player roster) Teams must have Coach/Supervisor and will receive a $100.00 refund if no games are forfeited Dates: Regular season Thursdays June 24th -August 5th With two Wedesdays TBA Game times: Thursdays (2 Wednesdays) 6:30pm (All games played at the same time) Teams : Individual players not associated with a team will be assigned to teams needing players to fill rosters or on house team Sendcheck or money order to:Visa and Master Card accepted Jersey Shore Summer Lacrosse League 388 Harper Avenue, Brick, NJ 08724 Players will not be permitted to participate without the following signed AMATEUR ATHELETIC MINOR WAIVER AND RELEASE OF LIABILITY In consideration of being allowed to participate in any way in the Jersey Shore Summer Lacrosse League, the undersigned: 1. Agree that the participant will prior to participation inspect the facilities and equipment to be used, and if the participant believes anything unsafe, he or she should immediately advise the supervisor of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used.Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death. 4. Release, waive, discharge and covenanant not sue Jersey Shore Lacrosse and it’s affiliated clubs, their respective administrators, directors, agents, coaches and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leassors of premises used to conduct the event, all of which are hereinafter referred to as “releasees”, from any and all liability to each of the undersigned, his or her heirs and the next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused in whole or in part by the negligence of the releasees or otherwise. I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I/WE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. Institute/ organization: Jersey Shore Lacrosse Print Participant’s Name:___________________________ Signed:___________________________Date:_________ Parent/Guardian if Minor Sign:_______________________