My my My my
 
 
 
 
 
 

Shape 

     Westwood Youth Lacrosse April Vacation Clinic  

Monday and Tuesday: April 15 and April 16, 9:00am - 12:00 noon  

                                  Grades 1-8. New players welcome. Program cost $35.00  

            Westwood High School, 200 Nahatan Street, Westwood, MA 02090   

                                        Players will need  a stick, goggles, mouth guard, water and a healthy snack. 

                                                     Clinic limited to 60 particpants: please register early, generally  fills by April 13, 2017  

                 Clinic Registration: 1. complete the information, sign the waiver below and mail to  

Westwood Girl’s Lacrosse, P.O. Box 229, Westwood, MA 02090  

2. Please make checks payable to Westwood Girl’s Lacrosse  

Questions: 617-462-5590 kathleenkmcdonough@hotmail.com  

Player Name: Age:   

Address:                                                          EMAIL:   

Home Phone:Emergency contact and phone:  

Health Insurance:Policy number:  

  

CONSENT TO PLAY AND LIABILITY RELEASE  

I acknowledge that lacrosse is a high-speed sport which may involve some contact. I am aware of  no medical conditions, illnesses or injuries that would prevent my child from participating in all aspects of  this clinic except as follows (Please state the medical condition and provide a letter from the child’s health care provider indicating the limitations or restrictions for the child’s participation):   

_______________________________________________________________________________  

  

I hereby give permission to provide emergency medical assistance to my child in case of accident or injury. I agree to indemnify and hold harmless Westwood Girl’s Lacrosse, any individual working as an officer, coach, employee, age agent or volunteer or in any capacity for this organization, for any and all injuries, damages, causes of actions or claims for personal injuries or property damage, arising from my child's participation in this program.  

  

Signature of Parent/Guardian: __________________________Date: ____/____/____