2016 Registration Form

INSTRUCTIONS:

Registration still OPEN as of 04/21/16 for the Following Grades:

Boys K (7 spots remaining)

Boys 1 (8 spots remaining)

Boys 2 (4 spots remaing)

Registration Is CLOSED for the following grades:

All Girls Grades

Boys Grades 3 - 8.

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If you have questions regarding registration please contact Rob Bednarik at registration@mojlc.org

Please complete all mandatory fields marked with a red flag. If registering more than one player, separate registration is required. One completed form per participating youth.

This registration form, as well as registering your child, is used to collect your contact information. We use this information to stay in contact with you regarding activities in the club.

Player Information

First Name *

Last Name *

Is this an additional child registered in our program 🛈

Yes

Street/Mailing Address *

Address Line 2

City *

State *

Zip Code *

Gender *

Male

Female

Date of Birth * +

Grade (as of March 2016) *

Played in league last year? *

Yes

Family Information

Home Phone *

Parent/Guardian

Parent/Guardian Cell Phone

Parent/Guardian Email Address *

Alternate Parent/Guardian Name

Alternate Parent/Guardian Cell Phone

Alternate Parent/Guardian Email Address *

Alternate Email Address 1

Who does this Email Belong to #1

Alternate Email Address 2

Who does this Email Belong to #2

Waiver of Liability:

I/We, the parents of the above named player, hereby grant my/our permission for his/her participation in any and all Club activities, during the current season. I/We assume all risks and hazards incidental to such participation, including transportation, to and from activities. I/We hereby waive, release, absolve, indemnify, and agree to hold harmless, the Mt. Olive Jr. Lacrosse Club, its organizers, sponsors, supervisors, participants, and persons transporting my/our child to and from activities, for any claim arising out of injury to my/our child. Except to the extent and in the amount covered by accident and/or liability insurance.

I/We agree to return upon request all equipment, including game uniforms, issued to my/our child, by the Mt. Olive Jr. Lacrosse Club, in as good of condition as when received, except for normal wear and tear.

I/We agree to furnish, upon request, a certified copy of my/our child’s birth certificate for age verification, so that they may participate within the New Jersey Junior Lacrosse League.

I/We hereby give my/our approval for the above applicant to participate in any and all Mt. Olive Jr. Lacrosse Club, New Jersey Junior Lacrosse League and US Lacrosse activities.

To participate within the New Jersey Junior Lacrosse League, all participants must be registered members of US Lacrosse. A portion of your registration fee will go toward fulfilling your child’s US Lacrosse membership requirements. US Lacrosse provides medical insurance and membership. League games will not be sanctioned under US Lacrosse Youth Council Guidelines without this coverage, due to liability concerns.

I have read the above liability waiver and agree to the terms indicated.

Name of Parent/Guardian completing this form *

Additional Forms -PLEASE READ

Medical Release Waiver Form (Download & Mail)

Code of Conduct (Download & Mail)

MOJLC Consent to Photograph (Download & Mail)

Form Acknowledgement

I acknowledge that I have read and agree with the terms in each form above.
Please complete, sign & return the Medical Release, Code of Conducts, and Consent to Photgraph mail to

MOJLC
P.O. Box 743
Flanders, NJ 07836

*

Medical Release Waiver

Code of Conducts(Players,Parents,Coaches)

Consent to Photograph

Registration Information

Acceptable payments: Paypal, Credit Cards, or Check

BOYS Registration

Boys K ($55) (20 remaining)	Boys 1st Grade ($55) (14 remaining)	Boys 2nd Grade ($100) (14 remaining)
Boys 3rd Grade ($220) (5 remaining)	Boys 4th Grade ($220) (5 remaining)	Boys 5th Grade ($220) (5 remaining)
Boys 6th Grade ($220) (5 remaining)	Boys 7th Grade ($220) (20 remaining)	Boys 8th Grade ($220) (5 remaining)

GIRLS Registration

Girls 2nd Grade($95) (4 remaining)	Girls 3rd Grade($95) (5 remaining)	Girls 4th Grade($95) (9 remaining)
Girls 5th Grade($180) (5 remaining)	Girls 6th Grade($180) (5 remaining)	Girls 7th Grade($180) (5 remaining)
Girls 8th Grade($180) (5 remaining)

REQUIRED FEE'S *

US LACROSSE FEE ($25)

MO RECREATION FEE ($10)

ONLY select this option when registering your 2nd, 3rd, or 4th child. 🛈

Apply Multi-child Discount ($50 off)

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