NLC Registration 2024
After you submit this registration form, please return to the website to complete the payment:
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Email *
Player Information
Player's First Name *
Player's Last Name *
Age on First Day of the Clinic *
Current Grade *
This is the grade the player is in NOW, not what grade they will be entering in the fall.
School Student Attends *
Select Your Program *
Parent/Guardian Information
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Email Contact - most frequently checked *
This is where we will send all schedules, announcements, and will be our primary way of communicating.
Parent/Guardian's Cell *
(###) ###-####
Street Name & Number *
Apt. or Unit Number if applicable
Town *
State *
Zip Code *
Emergency Contact
Other than Parent/Guardian
Name *
First & Last
Cell *
(###) ###-###
Email Contact *
Athlete Insurance Information
Insurance Company Name *
Insurance Policy # *
Family Physician Name *
Physician Phone # *
(###) ###-####
Waiver
Please read the following and check below: I/we give my consent to the above named player to participate in the NLC (Needham Lacrosse Clinic). I/we assume all risks and hazards incidental to the conduct of the activities and do further release, absolve, indemnify, and hold harmless the organizers, coaches, refs, and supervisors of the NLC. In case of injury to my/our participant, I/we waive any claims against those named above and anyone appointed by them. I understand that the activity I am participating in is a physical, high-risk sport and the I/they are participating in this club at my/their own risk with full knowledge of the dangers associated with participation. I have read the above paragraph and understand it fully. The release is checked off as my own free act and deed.
*
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Return to needhamlacrosseclinic.com to COMPLETE PAYMENT *
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