Champion Lacrosse Fall Registration Form
Complete this entire form.  Please print clearly.  If you have questions, call us at (248) 232-9964.

Student Name_____________________________________ Student Email _____________________________________

Parent Email 1 ______________________________      Parent Email 2 ______________________________________

Address ____________________________________    City _____________________________  Zip________  

Phone (_____) ______________    Gender  	___Male  ___Female 	Birth Date _____/_____/_____  

Year of High School Graduation _________    Grade ________     T-Shirt Size ___________________
(Grade this Fall): 12=2009. 11=2010, 10=2011, 9=2012, 8=2013, 7=2014, 6=2015, 5=2016, 4=2017, 3=2018, 2=2019, 1=2020, K=2021, PK=2022)

School ________________________________________  Position (if known) ______________________________

Please select a program.  If you are enrolling in Class & League Package, please select one of each.

Class Level
___Pre K - Kindergarten Lacrosse Class    
___1st – 2nd Grade Lacrosse Class    
___3rd – 4th Grade Lacrosse Class
___5th – 6th Grade Lacrosse Class
___5th – 6th Grade Boys Advanced Lacrosse Class (Sunday)
___Middle / High School Lacrosse Class
___Goalie class

Youth League
___Girls Youth League (grades 3 – 6, girls lacrosse rules).
___Grades K-2 Non-Equipment League (Boys and Girls)
___Grades 3-4 Boys Full Equipment League  
___Grades 5-6 Boys Full Equipment League

Class Participants Select One Item Below
___Warrior Lacrosse Stick
___Champion Lacrosse Practice Pack
___Training Shirt ________  Size

Leagues
___Middle School Boys
___JV Boys
___Varsity Boys
___Varsity Girls
___Men’s Rec 

Payment:  	Please make checks payable to
   	Champion Lacrosse
   	30700 Telegraph Road, Suite 3655
   	Bingham Farms, MI 48025

 		Lacrosse Class  (and a stick, shirt or practice pack)……………..……….	$150
		Youth League (and a jersey)………………………………………….…….	$150
*Package: Class & Youth League (stick/bag/shirt & jersey) …………….	$215
High School Middle School Leagues………………………………………	$145+$20 Jersey Deposit
		Men’s Rec League……………………………………………………….…..	$115+$30 Jersey Purchase
		**Early Registration (by or on 8/22………………………………………..	$ - 10
		**Late Registration fee (on or after 9/6)…………………………………...	$ +15	

Note: Men’s rec players who purchased a Champion Lacrosse rec
jersey during a previous session do NOT purchase a new one. 

Credit Card Payments

Name on Card __________________________________________  Exp Date _____________  CVV2 (Security Number) ___ ___ ___

Visa/MasterCard Number ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___

Credit Card registrations can also be faxed to (248) 232-6722.

CHAMPION LACROSSE ENROLLMENT AGREEMENT & RELEASE
The Participant desires to participate in a program of Premier Sports Group, Inc., doing business as Champion Lacrosse (“Champion”).  This form is an important legal document.  It is critical that you read and understand it completely.  After you have done so, please print your name legibly and sign below.  In this document, the term “Participant” includes both the on-the-field Participant and the parent or legal guardian, if Participant is under 18 years of age.
Participation in the sport of lacrosse may result in injury or death to Participants.  Participant desires to participate in the sport of lacrosse despite these risks.  Participation in the Champion program is expressly conditioned upon the following agreement by the Participant:
   1. Participant assumes all risks of injury or death sustained while participating in the sport of lacrosse or while on or about the premises, and waives all liability against Champion, the Birmingham Public Schools, their officers, employees and all affiliated entities.
   2. Participant releases, discharges, indemnifies and holds harmless Champion, the Birmingham Public Schools, their officers, employees, agents, officials and all related entities from any and all claims, demands or causes of action that are in any way connected with participation in the sport of lacrosse or use of the premises, facilities or equipment, and including any negligence on the part of Champion, the Birmingham Public Schools, their officers, employees, agents, officials and all affiliated entities.
   3. Champion is not responsible for Participant’s fitness, abilities or equipment.
   4. Participant represents and acknowledges that Participant has adequate insurance and agree to assume full responsibility for any and all costs or expenses occasioned by an injury or medical need arising out of participation in the sport of lacrosse or use of the premises, facilities or equipment.
   5. Participant acknowledges that during the course of their activities, Champion may take Participant’s photograph or video.  Each Participant hereby grants Champion permission to use any such photograph or video for use in materials promoting Champion.  Such use may include publication in program, general advertising, posters, flyers, television and any other vehicles that may be distributed or shown to or otherwise seen by large numbers of individuals and potential patrons of Premier Sports Group or Champion Lacrosse. Participant waives all rights to any financial remuneration of any kind.
    	I have read and I understand this Agreement.  I warrant that I have the right and the authority to execute this Agreement on behalf of myself and the Participant (if under the age of 18). I assume full responsibility for the terms and conditions of this Enrollment Agreement & Release, and will indemnify and hold harmless Champion for any claims brought by or on behalf of Participants to this Agreement.

__________________    	_______	__________________________________
Name of Participant	 	Date	     	Signature of Participant or Parent/Guardian

Please check our web site for updates.   We will communicate via email, so please make certain that the email address you have provided is accurate.  Call us with your questions at (248) 232-9964.  You can also link to our online registration at championlacrosse.com