Online Registration Form
  • Player Registration Section
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  • ATHLETE INFORMATION
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  • Last Name:*
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  • First Name:*
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  • Middle Initial:*
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  • Home Address:*e.g. 1234 Tree St. NE
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  • City:*
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  • State:*e.g. OR
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  • Zip Code:*e.g. 12345 or 12345-6789
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  • School:*
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  • Birthdate:*mm/dd/yyyy
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  • Grade:*
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  • Athlete Home Phone:*
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  • Athlete Mobile Phone:*
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  • Text/SMS?*
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  • Athlete Email Address:*
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  • Facebook?*
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  • Previous Lacrosse Experience:*How many years total?
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  • *
    Boys & Girls Club
    SKYLL
    Junior Varsity
    Varsity
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  • Athlete lives with:*
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  • Parent/Guardian
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  • First Name:*
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  • Last Name:*
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  • Email:*
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  • Home Phone:*
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  • Work Phone:*
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  • Mobile Phone:*
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  • Occupation:*
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  • CONSENT FOR MEDICAL TREATMENT
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  • I/we hereby give my/our consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my/our dependent.

    (In the event of injury during practice or game, every attempt will be made to contact both of the athlete's parents/guardians to inform them of the nature of the injury and to inquire as to desired location of treatment.)
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  • *
    I/we agree with the above
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  • INSURANCE INFORMATION
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  • Name of Insurance Carrier:*
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  • Insurance Contact Phone:*
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  • Group Number:*
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  • Policy Number:*
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  • Policy Holder's Name:*
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  • Is this an HMO?*
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  • Doctor's Name:*
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  • Doctor's Phone Number:*
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  • MEDICAL/EMERGENCY CONTACT
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  • Emergency Contact:*
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  • Home Phone:*
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  • Mobile Phone:*
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  • Relationship to Athlete:*
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  • List any preexisting medical conditions or allergies:
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  • *
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  • South Salem Lacrosse Club Player & Parent Conduct Contract Section
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  • Behavior that will not be tolerated:

    • Use of foul language in practice or games
    • Taunting or derogatory comments of any kind
    • Arguing with coaches or officials
    • Negative comments to team members
    • Disrespect to coaches, players, fans or school personnel

    Offenses will drastically reduce playing time or involve game suspensions.

    1st Offense – warning
    2nd Offense – 1 game suspension
    3rd Offense – 3 game suspension

    Any additional offense will result in the player being dismissed from the team.

    Practices are mandatory – any missed practices must be cleared with the coach before hand or must be accompanied by a note or call from the player’s parent.

    An unexcused absence from practice will result in a one-quarter suspension in the next game.

    Tardiness to practice will result in additional training after practice.

    Theft, destruction of property (whether school or personal), fighting, or any action on the field to deliberately injure another player (including body checks intended to do malicious harm) will result in an immediate dismissal from the team.

    South Salem Lacrosse Players are to play within the rules outlined by US Lacrosse and the Oregon High School Lacrosse Association. Any conduct deemed to be in violation of these rules will result in disciplinary action, ranging from game suspensions to dismissal from the team.

    Parents agree to act in a manner acceptable to the rules set by US Lacrosse and the Oregon High School Lacrosse Association. The use of vulgar or profane language, inappropriate jokes, arguing with coaches or officials, or any other action deemed inappropriate by coaches or officials will result in one warning. A second warning will result in your child being suspended from the game and your removal from the field. Further outbursts will result in your child being dismissed from the team. Any physical assault to officials, opposing team members or opposing fans will result in your child’s dismissal from the team. Please remember that any inappropriate actions will directly impact your child’s ability to participate.

    We have read and understand these rules and resulting disciplinary actions and understand them fully. By checking the boxes below we agree to all the above conditions.
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  • Player Name:*First and last name.
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  • *
    South Salem Lacrosse Player Agreement
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  • Parent or Guardian Name:*First and last name.
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    Parent or Guardian Agreement
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  • Conduct/Waiver and Release of Liability Section
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  • In consideration of
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  • Player Name:*First and last name.
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  • being allowed to participate in any way in the South Salem High School Lacrosse Club athletics/sports program and related events and activities, the undersigned:
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  • Certify that the above named athlete is in good health and that there is no physical or emotional reason prohibiting his/her participation in this program. Further, it is understood that a physical exam by a physician, prior to commencement of practice, will be required by all athletes who wish to participate in the South Salem High School Lacrosse Club program;

    Agree that as the parent(s) and/or legal guardian(s), I (we) will instruct the minor participant that prior to participating he/she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he/she should immediately advise his/her coach or supervisor of such condition(s) and refuse to participate, until such condition(s) are corrected;

    Agree that as the parent(s) and/or legal guardian(s), I (we) do fully understand my (our) responsibility to properly equip the above named Athlete with protective equipment allowed by NCAA rules to play the game, and accept full responsibility for assuring that the athlete wear a complete protective set of equipment when participating in any South Salem High School Lacrosse Club activity;

    Understand that South Salem High School Lacrosse Club is a non-profit organization operated by volunteers for the benefit of young people, independent from and receiving no funding, in-kind services, or supervision from the Salem-Keizer School District. Agree to treat all volunteers and officials of the Lacrosse program, including coaches and referees, with appropriate courtesy and respect. Realize that any violation of proper conduct may result in the above-named player being dismissed from the Lacrosse program without refund of fees. Further understand that all volunteers, including coaches, ARE volunteers and not professionals, and can only provide their best judgment and knowledge in instructing, guiding and making decisions for the above-named player;

    Understand that the success of the South Salem High School Lacrosse Club program is based entirely upon the donated work of volunteers and will try to volunteer my (our) services in order to provide an enjoyable, educational, healthful, and athletic experience for all participants;

    As the parent(s) and/or legal guardian(s), I (we) do fully understand and agree that I (we) and the Registrant will abide by the rules set for varsity athletics at South Salem High School, allow the Athletic Director to release academic eligibility information, recognize the possibility of physical injury associated with Lacrosse and in consideration for the Salem Keizer School District and the South Salem High School Lacrosse Club accepting the Registrant for its Lacrosse program, I (we) hereby release, discharge, hold harmless and/or indemnify the Salem Keizer School District and the South Salem High School Lacrosse Club, its officers, directors, coaches, volunteers and parents, including owners of the fields and facilities utilized for the sport, against any claim by or on behalf of the Registrant as a result of the Registrant’s participation in Lacrosse and/or being transported to or for the same, which transportation I hereby authorize.

    I/we have read the above waiver and release, understand the contents, and sign it voluntarily.
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  • Parent or Guardian Name:*First and last name.
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    Parent or Guardian Agreement
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  • Player Name:*First and last name.
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    South Salem Lacrosse Player Agreement
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