2022 Frozen Fives - Player Waiver and Emergency Contact Form
This online form must be signed by the parent/guardian of each player participating in the Frozen Fives.
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电子邮件地址 *
Team Name *
Player Name *
Email *
Parent/Guardian Name *
Parent/Guardian Contact number *
Emergency Contact Name *
Emergency Contact Number *
Insurance Information:
As parent/ guardian, I understand the risks involved with, my child participating in the Frozen Fives lacrosse event.  I verify my child has no physical impairments that increase risk of injury.  I understand and agree that Moonlight Lacrosse and its agents assume no responsibility above normal liability insurance coverage for any injury during this function.  I authorize personnel to act accordingly in the event of a medical emergency.  I also understand that Armonk Indoor Sports Center is not responsible for lost or stolen personal items.

Parent/Guardian Signature (Type name below) *
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