01.2017.PD2_October 29th_Bryant Lacrosse Prospect Day
Please complete for each player.
Player's First Name
Player's Last Name *
Date of Birth
Year of HS Graduation
select class year from below
Name of School
EMERGENCY CONTACT INFORMATION
Name of EMERGENCY Contact
Relation to Player
Emergency contact Phone Number (during Clinic hours)
PLAYER CONTACT INFORMATION
Telephone with area code
** IMPORTANT -ALL information regarding the clinic and your registration will be provided by email, please be sure to provide an email which is regularly checked.
Parental Consent: The undersigned being a parent or legal guardian of the child requesting camp admittance, does hereby affirm that the applicant is in good health, and suffers from no illness, disability or condition that requires the taking of medication on a regular basis unless that condition is disclosed and approved. Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity. The undersigned expressly agrees to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to allowing any of the camp supervisors to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent. The Bryant Lacrosse Camp / Clinic provides no primary medical insurance. I understand that, as a condition of admittance as a participant in the camp, the undersigned, on behalf of all parents and guardians and on behalf or the applicant, hereby releases The Bryant Lacrosse Camp / Clinic, Presslax, Bryant University, the Bryant University Athletic Department, Mike Pressler and all other employees or agents of the camp from any and all liability from injury or illness, mental or physical, suffered by the camper during or related to camp, unless caused by willful act or gross negligence by the person or entity against whom the claim is made.
I have read, understand and agree to the terms stated above
I agree. that I am over the age of 18years OR the parent/legal guardian of a minor under 18 years of age.
Please type your name
CANCELLATIONS - Clinic Refund Policy
BEFORE October 18th, Full Refund less $50 administrative fee; Medical ONLY, Physician’s Note Required After October 18th, Full Refund less $50 administrative fee; No Refunds, for any reason, AFTER October 20th. REQUESTS must be made in writing, by email: Bryant_mlax@bryant.edu