Pure Premier Summer 2021 Registration Team Registering For*Pure PremierPlayer Name*Please double check spelling of the last name. First Last Date of Birth* Date Format: MM slash DD slash YYYY Graduation Year - Pure Premier*20222023What is your Uniform number?*Position (Select One)*GoalieDefenderMidfieldAttackSchool DistrictPlease enter your school districtPure Premier*Half PaymentFull PaymentTotal $0.00 Phone*Main Email* Enter Email Confirm Email Alternate EmailUse this field to add a 2nd email address Enter Email Confirm Email I will inform my child’s coach prior to participation in any physical activity if my child is sick or injured and should not play or practice. I have supplied Pure Advantage Lacrosse (The Club) with adequate contact information including telephone numbers that should be used to contact an adult representative (usually, the player’s parents or guardians) who are authorized to permit administration of medical treatment. If my child is injured during a practice or game I consent to minor medical treatment such as ice, bandages, etc… as a temporary solution to alleviate my child’s condition. I agree to make arrangements, schedule appointments and pay associated costs if my child needs professional medical treatment. I understand that participation in athletics has risks of injury. I accept that my child may become injured. I willingly accept this risk and agree to hold The Club and its representatives harmless for injuries sustained by my child for participation in athletics. I hereby release, discharge, and/or otherwise indemnify the Pure Advantage Lacrosse, its affiliates, organizations, and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the programs, against any claim by or on behalf of myself as a result of any participation in the programs and/or being transported to or from the same which transportation I authorize. ALL PARENTS (IF A PLAYER IS UNDER 18) MUST SIGN BELOW TO ACKNOWLEDGE HAVING READ AND UNDERSTOOD THE ABOVE.Player/Parent/Guardian Signature (Please Type Name)*The person named above must sign this form. Due to the electronic nature of this registration form, please type your name in the above field. By doing so and submitting this form, you acknowledge and accept the terms of the above disclaimer/waiver of liability. If the player is less than 18 years old on the day this form is filled out, a parent or guardian is required to type his/her name in the field below.Today's Date* Date Format: MM slash DD slash YYYY Parent/Guardian's Name* This iframe contains the logic required to handle Ajax powered Gravity Forms.