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CONSENT FORM

All players under the age of 18 must have a parent or guardian's consent prior to being able to participate. Parent or Guardian may fill the online consent and registration form and submit payment.

Please complete and return to your coach or parent organizer:

All forms must be sent with payment to:

Fee: $65/player.  Please remit check to: The Elite 150, Inc.
Tom Gravante, Men’s Lacrosse       Email: gravante@msmary.edu
Mount St. Mary’s University                      (O) 301.447.5356
16300 Old Emmitsburg Rd.                      (C) 301.471.8206
Emmitsburg, MD 21727                           (Fx) 301.447.6723

Name:	______________________________________	Position:	A M D G (circle)
Address:	______________________________________	Grad. Year:	________________________
	______________________________________	Coach’s Name:	________________________
HOME #	____________________________	Coach's Phone:	________________________
Cell #	____________________________	Coach's Email:	________________________
Email address:	______________________________________	Team Division	JV or Varsity (circle)
Team Name:

Parent/Guardian consent:
I hereby authorize the Elite 150 Lacrosse Camp to act on my behalf according to their best ability in any medical emergency. I verify to the best of my knowledge that the above named applicant is physically able to participate in all lacrosse activities. I, parent/guardian of the above lacrosse player, certify that he is covered by medical/health insurance, and has no chronic ailment or recurrent injury, which might endanger his well-being while participating in lacrosse activities/games. I further understand that lacrosse is a contact sport. As a participant in a contact sport, the player above accepts a certain responsibility to play in a sportsmanlike manner and for the normal, inherent risk of athletic injury. I, the undersigned, waive and forever discharge Mount St. Mary’s University, Tom Gravante, and The Elite 150 Lacrosse Camp, its staff, officers, representatives, employees, and successors from any and all rights and claims for damage to person and property while at this lacrosse site.

Parent/Guardian Signature:________________________________________________________  

DATE______________________