Player Registration Information *

First Name

Last Name

Parent Name *

First Name

Last Name

Parent Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Player Birthday *

MM

DD

YYYY

Waiver & Release of Liability *

I, the parent/guardian of the named participant, understand that participation in lacrosse involves inherent risks, including the risk of serious injury. In consideration of participation in any and all programming presented by SHOUT OUT LAX, I hereby release and hold harmless SHOUT OUT LAX, its officers, staff, coaches, volunteers, and agents from any and all liability for injuries, damages, or claims resulting from participation in this program.

I accept.

Photo & Media Release *

By signing below, I grant SHOUT OUT LAX permission to use photographs, videos, and other media taken during sessions or events that include my child for promotional and marketing purposes, including (but not limited to) social media, flyers, websites, and newsletters. I understand that my child’s full name will not be used in public-facing materials without additional consent. If I wish to opt out of this release, I will notify SHOUT OUT LAX admin in writing before the start of the program.

I accept.