2012 Winter League at Holy Angels 6 Sundays: 1/8, 1/15, 1/22, 1/29, 2/5, 2/12 10:00 AM – 12:30 PM 1 game each week Room for 4 full teams (1 goalie per team) $135 (includes team jersey) 2012 Winter League at Holy Angels Step 1 of 2 50% Name*FirstLastDate of Birth* Email*Guardian's Email*Address*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip CodeHome Phone*Mobile PhoneT-Shirt SizeSmallMediumLargeXtra LargePositionDefenseMidfieldAttack** Goalie positions are full.Years PlayedCarpool requestsWe will attempt to place players together if they request it, but be aware that this is not always possible due to roster size limits, late requests, conflicting interlocking request, etc. Participant Primary Insurance CarrierPolicy NumberConsent & Agreement:Acceptance of Participation: In accordance with the rules of the 2012 Lax Connections program I give my consent and approval for my daughter to play lacrosse.Readiness to Compete: I believe my daughter is physically and psychologically prepared to compete in the program.Medical Attention: I hereby give my consent to the 2012 Lax Connections sponsors to provide through medical staff of its choice, transportation and emergency medical services as warranted in the course of my daughter's participation in this 2012 program.Waiver and Release: I am fully aware and appreciate the 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. I further agree on behalf of my daughter, myself, my heirs and personal representative, that the 2012 program, Lacrosse Connections, LLC, the host facility, along with coaches, volunteers, employees, agents, officers and directors of the organizations, shall not be liable for any injury, loss of life, or other loss or damage occurring as a result of my daughter's participation in the league.Approved Equipment: I hereby certify that all equipment (including goggles, goalie helmets, lacrosse sticks, and all other goalie gear) used by my daughter in the 2011 program meets standards required by US Lacrosse.*I Agree to the aforementioned Consent & AgreementRegistration FeePrice: $135.00NameThis field is for validation purposes and should be left unchanged.