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Entering Grades 7 & 8 <br />Boys Lacrosse League <br />Registration meeting will be held at Roseville Fire Station#1 on Lexington and Woodhill in the Basswood Room, <br />from 6:30-8pm, on Thursday, Feb 26, 2009. Practice will begin March 31, weather permitting, at Langton Lake <br />Park, 6:30-8pm. Games played on Saturdays starting April 18. Schedules will be posted at www.mbsla.org. All <br />players must have a US lacrosse youth membership. Equipment must be regulation lacrosse this year, includes <br />black helmet, gloves and elbow pads. <br />$160 Entering Grades 7 & 8 <br />#2600.214 T/SA Mar 31– May 16 6:30-8pm Langton Lake Fields <br />City of Roseville Parks and Recreation <br />Register in person or by mail at 2660 Civic Center Drive, Roseville, MN 55113 <br />or Online: www.cityofroseville.com/parks <br /> <br />Participant:_____________________________________Phone: (h)_________________ (w)_____________________ <br /> <br />Address:__________________________________________________ City:__________________________State:_____ <br /> <br />Zip:_____________ <br /> <br />Gender: F M Birthdate:__/___/___ Fall Grade _____ <br /> <br />Parent Name:_________________________ E-Mail:__________________________________________________ <br /> <br />Does the participant have any special needs, disability, or allergy that the staff should be aware of? Yes No <br /> <br />Please explain:______________________________________________________________________ <br /> <br />Prog #__________________ Program Name:_________________________________ Total Fee:______________ <br /> <br />Prog #__________________ Program Name:_________________________________ Total Fee:______________ <br /> <br />Prog #__________________ Program Name:_________________________________ Total Fee:______________ <br /> <br />Prog #__________________ Program Name:_________________________________ Total Fee:______________ <br /> <br /> <br />___Check ___Cash___Visa___MC Name on Card:____________________________________________________ <br /> <br />Credit Card #:__________________________________________________________ Expiration:___/_____ <br /> <br /> <br /> The information requested on the registration form will be used to verify eligibility and determine staff, faculty and <br />Tennessen Warning: <br />equipment needs. You/your child’s name, age, grade level, address, telephone number and health information will be provided to appropriate <br />City staff, volunteers, City Attorney, insurer and auditor. Although you are not legally required to disclose the information, failure to do so <br />will prevent you/your child from participating in the program. <br /> <br />I understand that participation in this activity is completely voluntary. I recognize that there are risks in my participation in <br />Liability Waiver: <br />this activity. I agree to accept those risks. I also agree, in consideration for my being allowed to participate in this activity, and on behalf of <br />myself, my heir, executors, administrators and assigns, to release and discharge the City of Roseville, sponsors of the event or activity, and <br />their officers, employees, agents, successors and/or assigns from liability for any and all injury, damage or loss that is or may arise from my <br /> <br />participation in this activity. <br /> <br />