Salt Lake Summit Lacrosse Club Winter 2020 Performance Camp Registration Salt Lake Summit Lacrosse Winter CAMP Registration - 2020 Athletes Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Position*AttackMidfieldDefenseGoalieLSM (Long Stick Mid)Defense MidX AttackmanDate of Birth* MM DD YYYY Gender*MaleFemalePrefer not to sayWeight (in pounds)*Mobile Number*Email* Enter Email Confirm Email This email will be used for confirmation of registration, billing, and any other notices being sent out.Emergency Contact Name* First Last Emergency Contact PhoneInsurance Provider*Insurance Number*Injury HistoryTraining GoalsTerms and Conditions* I am 18 years or older, and I have read and agree to the below terms and conditions. I am a parent or guardian, and I have read and agree to the below terms and conditions in my child’s behalf. As a condition of my/my child’s participation in the CAMP, Building Better Athletes, LLC, Training (hereinafter CAMP training), and in consideration for the privileges that come from participation in that training which may include instruction, use of facilities and equipment and other services provided by CAMP, Building Better Athletes, LLC I hereby agree for myself and/or for my minor child as follows: 1. I recognize that the CAMP training will involve various activities that may include, but are not limited to, instruction, conditioning, practices, games, and travel to and from CAMP training. 2. I recognize that there are certain risks of harm to me and others associated with my participation in CAMP training and activities, that there are dangers that cannot be fully foreseen, that there are risks and dangers that CAMP, Building Better Athletes, LLC and its agents and employees cannot control, and that such risks and dangers could result in bodily injury or death to me/my child and/or to others. 3. I understand that some of the dangers and inherent risks to me/to my child in playing or practicing to play in any sport include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury related to the eye and/or head, serious injury to virtually all internal organs, serious injury to all bones, joints, ligaments, muscles, tendons, and other parts of the muscular/skeletal system, and serious injury or impairment to other aspects of my/my child’s body and general health and well-being. I further understand that that are risks associated with travel and that I/my child could incur some or all of these injuries during travel to and from CAMP training. 5. I acknowledge that CAMP training has strongly recommended to me that I/my child seek medical advice concerning my/my child’s physical health, conditioning and abilities, prior to engaging in any CAMP training and activities. I further acknowledge that I do not/my child does not have any medical conditions that would affect my/my child’s fitness to participate in CAMP training and activities. 6. I agree that if any injury or emergency should occur during CAMP training and activities with respect to myself/my child, the CAMP, Building Better Athletes, LLC staff is authorized to take whatever steps are reasonably necessary in their judgment to attend to my/my child’s medical needs. I agree to be responsible for any hospital expenses, doctor bills, or other expenses that may be incurred to attend to my/my child’s medical needs. 7. I represent that I have/my child has adequate health insurance to cover the costs of treatment in the event of any injury that I incur/my child incurs during participation in the CAMP training and activities. 8. I agree to assume all risks and responsibility for any and all claims for damages, including personal injury or death, medical expenses, disability, lost wages, loss of earning capacity and property damages which may be incurred by me/my child while engaged in CAMP training and activities.9. I agree to allow CAMP, Building Better Athletes LLC. to use my/my child's name, picture, or likeness on its website or any other promotional material.10. I agree to assume all risks and responsibility for any and all claims for damages, including personal injury or death, medical expenses, disability, lost wages, loss of earning capacity and property damages which may be made by others and that result in part from my/my child’s participation in CAMP training and activities. 11. I agree to indemnify and hold harmless CAMP, Building Better Athletes, LLC and their agents and employees from any loss liability, damage or costs, including court costs and attorney fees, that they may incur due to my participation in CAMP training and activities, whether caused by my/my child’s negligence, the negligence of others and/or by the negligence of CAMP, Building Better Athletes, LLC. In signing this Release, I acknowledge and represent that I have carefully read the foregoing, that I understand it, and that I sign it voluntarily as my own free act and deed. No one has made any oral representation, statements, or inducements in order to get me to sign this document. I have had the opportunity to consult with my own legal counsel before signing this document. I also acknowledge that this Agreement shall bind my heirs and personal representatives. I am signing this Agreement on behalf of a minor Participant. This Agreement shall be binding upon the Participant and the Participant’s parents, guardians, heirs and personal representatives.