CANCELLED RPI Prospect Day - June 1st
June 1st Prospect Day Cancelled. Please visit https://forms.gle/U8QKSP9G5GYhFCwE7 to register for July 28th Prospect Day.
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Email *
Prospect's First Name *
Prospect's Last Name *
Address *
City *
State *
Zipcode *
Home Phone
Prospect's Cell Phone *
Parents Names *
Parents Cell Phone Numbers *
High School *
Club Team *
High School Graduation Year *
Position(s) *
Required
T-Shirt Size *
Emergency Contact Name *
Emergency Contact Cell Phone *
I am the parent/legal-guardian of, (“Player”) who has my permission to participate in the RPI Lacrosse Experience in Troy, NY on Saturday, June 1, 2019. I know that lacrosse is a contact sport that is inherently dangerous and involves risks of injury or even death. Furthermore, I acknowledge that there are ever-present risks in life generally and that during my child’s involvement in the RPI Lacrosse Experience, there will be such risk. I knowingly and voluntarily assume these risks, and hereby release and hold harmless RPI, and all of its agents, representatives, and assigns from all liability, claims, rights or causes of action which may accrue as a result of personal injury or property loss or damage sustained by Player arising out of, or as a consequence of, Player’s participation in the RPI Lacrosse Experience.I hereby authorize RPI personnel to authorize the performance of emergency treatment for children who incur injury or become ill, whose parents or guardians cannot be reached through reasonable efforts under the circumstances, I can best be reached through the emergency contact number provided. As a parent/guardian, I authorize the treatment of my child by a qualified and licensed medical professional, in the event of injury or sickness for which medical and/or surgical treatment is deemed appropriate by a qualified and licensed medical professional. This release is effective during any period of time in which my child is participating in the RPI Lacrosse Experience on Saturday, June 1, 2019. I also hereby acknowledge my full and sole responsibility for payment of fees or costs for any treatment that my child receives pursuant to this Consent. Please type your full name below to sign & agree to this Assumption of Risk/Release. *
Facts concerning the child’s medical history including allergies, medications being taken, medications causing an allergic reaction, and any physical impairment of condition about which a physician should be alerted. *
Family Doctor's Name & Phone Number *
A copy of your responses will be emailed to the address you provided.
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