Best Newport Beach Costa Mesa High School Club Lacrosse Teams, Camps, Clinics, Private Lessons, Tournaments, Programs

My my My my

Participant Information  - All Fields Required - PLEASE PRINT LEGIBLY

Name Last_______________________________First__________________________________MI___

Address ____________________________________________________________________________

City ____________________________________________ State _________ Zip __________________

Age _______ DOB _____/_____/_____ Grade _____ School __________________________________

Parents or Legal Guardians Names___________________________, __________________________,

Home Phone (_____)___________________ Cell (______)___________________

Parent’s E-Mail 1 __________________________________Cell (____)_________________________

Parent’s E -Mail 2 _________________________________Cell (____)_________________________

Position (circle): Unknown • Att • Mid • Def • Goal

Experience Level: Beginner, 1-2 Yrs, 3/More Yrs

Height______ Weight ______ Uniform Size XS, S, M, L, XL, XXL

Medical Information - All Fields Required

Name of Physician _______________________________, M.D. Phone (_____)___________________

Special medical problems, allergies, injuries etc: ____________________________________________

In the event of an emergency, please contact the following:

Name ________________________________ Name _________________________________

Relationship to Participant ________________Phone (____)____________ Cell (____)____________

Relationship to Participant ________________Phone (____)____________ Cell (____)____________

Name of Insurer _________________________ Policy Number: ______________________________


Parent/Legal Guardian signature or acknowledgement in agreement box below is Required to Participate.

In consideration of my son/daughter’s participation in Newport Beach Lacrosse, I agree to the following indemnification:

1. Waiver and Release: I am fully aware of and appreciate the possible risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event, practice, game, tournament, camp, clinic, private lesson and/or related sports conditioning activity associated with the sport of lacrosse and those services provided by Newport Beach Lacrosse.

Furthermore, along with Newport Beach Lacrosse ownership, its coaches, players and their respective parents/guardians, officials, referees, volunteers, employees, agents, sponsors, officers, and directors of affiliated organizations and their respective events, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my son’s/daughter’s participation in any Newport Beach Lacrosse event, league, practice, game, tournament, camp, clinic, private lesson, or sports conditioning activity.

All participants understand that they must have their own insurance coverage and/or at the very least are required to be current members of US Lacrosse.  Expenses resulting from injury or illness are the sole responsibility of the participant and/or his parent or guardian.

I understand that this program is not affiliated, owned, or administered by the Newport Mesa Unified School District.

2. Medical Attention: I hereby give my consent to Newport Beach Lacrosse to provide or assign to a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my son/daughter’s participation in any Newport Beach Lacrosse sponsored events or those its club teams participate in, whether they be in my presence or in lieu of my absence as such an occurrence may require.

3. Readiness to Compete: My son/daughter will only participate in those competitions or activities in which I/We believe he/she is physically and psychologically prepared to participate.

4. General Acknowledgement: As Parent/ Legal guardian of this participant, I hereby verify by my signature below or by my acknowledgement by checking the box below, that I/We have read and fully understand each of the above Waiver & Release Conditions and fully agree, comply, accept, and allow permission for my/our child/children to participate in any Newport Beach Lacrosse events and affiliated activities, and FULLY indemnify Newport Beach Lacrosse in its entirety and its parts from ANY loss or damage to each of the above conditions, especially the waiver and release set forth in the paragraphs above.


Newport Beach Lacrosse is dedicated to providing its participants with a quality lacrosse experience that combines instruction and competition with the opportunity to develop as a player and as a teammate. In its efforts, Newport Beach Lacrosse is committed to preserving the honor of the great game of lacrosse and the spirit of friendly competition. To help fulfill its mission, Newport Beach Lacrosse expects that all participants and his/her parents/guardians abide by a Code of Conduct. Failure to do so may result in immediate expulsion from any event without compensation or refund.

Players, coaches, officials, parents and spectators are to conduct themselves in a manner that demonstrates respect to other players, coaches, officials, parents, spectators, and fans.  In becoming a member of this organization, an individual assumes certain obligations and responsibilities to the organization and its participants. The essential elements in this Code of Conduct are HONESTY, INTEGRITY, and GOOD SPORTSMANSHIP. Those who conduct themselves in a manner that reflects these elements will bring credit to themselves, their team and their organization. It is only through such conduct that our organization can continue to earn and maintain a positive image and make its full contribution to our sport, our community and your child.

The following essential  elements of the Code of Conduct must be followed:

1. Sportsmanship and teaching the concepts of fair play are essential to the game and must be taught at all levels and developed both at home and on the field during practices and games.

2. The value of good sportsmanship, the concepts of fair play, and the skills of the game should always be placed above winning.

3. The safety and welfare of the players are of primary importance.

4. Players should always demonstrate positive behavior and respect toward teammates, opponents, coaches, officials, parents, and spectators.

5. Coaches, players, parents and spectators are expected to demonstrate the utmost respect for officials and reinforce that respect to players/teammates.

6. Grievances or misunderstandings between coaches, officials or any other parties involved with the organization should be communicated through the proper channels and procedures, never on or about the field of play in view of spectators or participants.

7. Spectators involved with the game must never permit anyone to openly or maliciously criticize, badger, harass or threaten an official, coach, player or opponent.

8. Eligibility requirements, at all levels of the game, must be followed. Rules and requirements such as age, previous level of participation, team transfers, etc, have been established to encourage and maximize participation, fair play and to promote safety.

9. Participants are expected to conduct themselves in a manner that honors the game and demonstrates respect for other players, coaches, officials and spectators.

10. Performing, permitting, encouraging, or condoning actions that are dangerous or demeaning to a player, coach, official or spectator is unacceptable and are grounds for immediate removal from the program with no reimbursement.

11. Participants are not permitted to be in the possession of or under the influence of alcohol, drugs, and/or tobacco products.

12. Participants are not permitted to be in the possession of weapons.

13. Participants are expected to wear all of the necessary and required equipment for participation in lacrosse.

14. Participants are expected to report any and all injuries IMMEDIATELY to a member of the coaching staff.

15. Participants are expected to treat all Newport Beach Lacrosse facilities with respect.

16. Newport Beach Lacrosse will not tolerate any actions of vandalism or actions that result in damage to property.

17. Newport Beach Lacrosse will hold participants legally and financially responsible for any and all damages they may cause to the property or facilities used by Newport Beach Lacrosse.

18. A US Lacrosse Membership is required for each participant that registers and participates.

US LACROSSE # _______________________

_________________________________ _____________________
Signature of Parent/Legal Guardian          Date

_________________________________ _____________________
Signature of Parent/Legal Guardian          Date

_________________________________ _____________________
Signature of Player/Participant                  Date

Player form of payment check /credit card/ cash / payment plan Amount paid:_________________