Fall 2022 Ind Player Registration: JV In order to register, your team must be listed below. Select your JV from the menu below. Registration is complete only with completed payment. A processing fee is assessed for anyone seeking a conflict refund or to change a player's personal information. For that reason, PLEASE REVIEW PLAYER INFORMATION BEFORE SUBMITTING. 1 Personal Info2 Waiver Info3 Payment Info Birth Date* Date Format: MM slash DD slash YYYY Player Name* First Last Select Your JV Team (Players paying individually by credit card)Select Your TeamSelect Your JV Team (Teams Paying by Check)Select Your TeamWM WhiteCSH RoarMaroons 2Smithtown EastSmithtown WestGraduation Year*Has The Player made a College Verbal Commitment?*YesNoPosition*Select Your PositionAttackMiddieDefenseGoalieLong Stick MidFOGOPlayer Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican 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 RicoQatarRéunionRomaniaRussiaRwandaSaint 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 IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Phone* Do You Have an Active US Lacrosse Member Number?*YesNoPlease enter your US Lacrosse number*US Lacrosse Number Expiration Date* Date Format: MM slash DD slash YYYY By agreeing below, I acknowledge that I have read and understand this form and further understand the terms herein are contractual and not a mere recital.* I agree In consideration of participating in the National Lacrosse Invitational at Ward Melville, the player named above and the parent or guardian do hereby agree for ourselves, our heirs, executors and administrators, to release, hold harmless and forever discharge NLIWM and their officers, staff, administrators, volunteers, sponsors and representatives and assigns, for and against any and all claims, actions, cause of actions, suits, judgments, and demands whatsoever directly or indirectly in connection the player’s participation in the NLIWM. TREATMENT/MEDICAL RELEASE AUTHORIZATION* I agree I/we being the legal guardians of the applicant authorize the staff of the NLIWM and its agents permission to request treatment to ensure the well being of our dependent. I certify that he is in good health and able to participate in the scheduled games.Refund Policy* I agree Refunds are determined on a case-by-case basis. If you feel a refund is necessary for any reason, please send an email to firstname.lastname@example.org with all pertinent information about your situation prior to the start date of the event. Any refund that is approved for the following reasons: (family emergency, travel, non-verified injury) will result in a $20 administrative charge. Any refund that is approved for the following reasons: (doctor-verified injury, multiple registration) will result in a $10 administrative charge. No refunds will be approved after the event starts.COVID-19 WAIVER, CONSENT, RELEASE OF LIABILITY I have read, understood and agree to abide by the guidelines, terms and rules as they are laid out above for the Waiver of Liability, Age Verification, Consent and Release. By checking the box below you agree to all conditions stated above in the Covid-19 waiver for MLRLAX Inc. Additionally, by checking the box it acts as a parental/guardian signature for your son's participation within all MLRLAX INC/NLI Lacrosse events, travel requirements and all other MLRLAX INC/NLI Lacrosse activities. COVID-19. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. MLRLAX INC, has put in place preventative measures to reduce the spread of COVID-19; however, MLRLAX INC and NLI Lacrosse cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending MLRLAX Inc and NLI Lacrosse programs or events could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending MLRLAX INC/NLI Lacrosse programs or events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at MLRLAX INC/ NLI Lacrosse programs or events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, MLRLAX INC/ NLI Lacrosse employees, volunteers, and program participants and their families. Further, I attest that my child(ren) are healthy now and will be monitored by me, a parent, or a guardian before attending all MLRLAX INC/ NLI Lacrosse programs or events each day and I will hold him out if any such symptoms arise. A health monitorization or check ensures and confirms that your child(ren) has not had these symptoms for 48 hour prior to each MLRLAX INC/ NLI Lacrosse program or event; fever, abnormal cough of any kind, shortness of breath, body aches, sore throat, or loss of taste and smell. I attest that my child(ren) has not knowingly been in close contact with anyone who is known to have or be symptomatic of the Covid-19 virus and has not traveled outside the US or been in contact with anyone who has traveled outside the US in the last 14 days I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any MLRLAX INC/ NLI Lacrosse program or events that MLRLAX INC/ NLI Lacrosse e or participation at MLRLAX INC/NLI Lacrosse programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless MLRLAX INC/ NLI Lacrosse, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of MLRLAX INC/ NLI Lacrosse, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any MLRLAX INC/NLI Lacrosse program. I HAVE READ THIS WAIVER AND RELEASE. I UNDERSTAND IT AND I AM SIGNING IT VOLUNTARILY. I certify that as parent/guardian of the athlete, I consent to his/her agreement to be bound by each of the terms and conditions in this waiver and release and age verification. Credit Card Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Visa and Mastercard Only.Please review all of your submitted information. There is a $50 fee associated with changing this information in the future for our player book. If anything is incorrect, please go back and change it by clicking "Previous".