Detroit Youth Lacrosse Indoor Registration 2018-2019
Register for lacrosse practice this indoor season! Learn the game with us, sharpen your skills, and get individualized coaching! Boys and girls ages 8-14 are welcome!

Detroit Youth Lacrosse practice begins in the new year at the Detroit City Fieldhouse!

Times, Dates:
DYL Blue (ages 10 and under) Monday 5-6pm, Thursday 6-7pm
DYL Orange (12 and under) Monday, 5-7pm, Thursday 6-7pm
DYL Black (14 and under), Monday, 5-7pm, Thursday 6-7pm

Location: 3401 E Lafayette St, Detroit, MI 48207

Sign in to Google to save your progress. Learn more
Email *
Parent(s)/Guardian(s) Name *
Address *
City *
Cell Phone Number *
Other Phone Number
Child's Last Name, First Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age (as of Sept 1st of this year) *
Current Grade *
Child's Gender *
Child's Shirt size *
What practices are you registering for? *
Emergency Contact *
Emergency Contact Phone Number *
Please provide information about any allergies or medical conditions that the coach should have in case of emergency. *
Does your child have any current conditions that limit his/her ability to participate in this activity? *
If “yes”, please explain and identify any modification that would enable your child to participate.
Permission and Waiver
I, as I name myself below, by signing this wavier, acting on behalf of my organization, myself or my minor child do expressly and forever waive, release, and hold harmless and indemnify the Chandler Park Conservancy and its partners from and against any and all claims, demands, obligations, causes of action and lawsuits, and all damages, liabilities, fines, judgments and costs (including reasonable attorney's fees) associated with, arising from or alleged to have risen from the actions or omissions of myself, my minor child or the organization, its agents, employees or contractors, in connection with the event, or any failure to comply with the laws, ordinances, rules and regulations applicable to the duties and responsibilities set forth herein. The Chandler Park Conservancy reserves the right to revoke this reservation should any information herein be found to be inaccurate or untrue. In consideration of being allowed to participate in any way in Chandler Park Conservancy’s Youth Sports Programs, the undersigned acknowledges, appreciates, and agrees that:The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the releases from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.PHOTO/VIDEO RELEASE: By registering for any Chandler Park Conservancy Sports Program, I agree to allow publication of photos or video taken of my child/children or myself at any program, event or facility associated with the Chandler Park Conservancy. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Parent/Guardian Name *
Parent/Guardian Signature *
Date of Signature *
MM
/
DD
/
YYYY
Hard copy of Permission and Waiver (for your reference, NO need print/fill out and submit)
 DYLA PARENT PLEDGE
Chandler Park’s #1 focus is the kids at hand and we thrive on providing a positive, safe, and fun environment for children to learn and play sports.  Therefore, we ask that you review and sign this pledge before enrolling your child in the camp.
 
The core values of the DYLA:
 
I WILL emphasize being a good sport and the importance of sportsmanship.  I will respect the game, other players’, coaches, and all staff members.
 
I WILL be supportive through success and mistakes.  I will be there to support my child emotionally and continue to be proud no matter the outcome, knowing that mistakes are okay and a part of learning and building.
 
I WILL demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I will refrain from their use at all sports events.
 
I WILL take responsibility for ensuring my child arrives to the program on time and is dressed properly to participate in sporting activities.
 
 
*I will abide by all guidelines listed above.  I understand that if I fail to meet the expectations of the Parent Pledge, Chandler Park Conservancy has the right to penalize myself.

Name of Child *
Date *
MM
/
DD
/
YYYY
Parent/Guardian Signature(s) *
Hard copy of DYLA Parent Pledge (for your reference, NO need print/fill out and submit)
PARENT INFORMATION SECTION

The following vital information for all parents with children participating in the program.  Please review the points and keep this sheet to refer back to if needed.

INCLEMENT WEATHER DAYS: On days of inclement weather (thunderstorms, rain, etc) DYLA will NOT meet. Parents will be notified of inclement weather days as soon as Chandler Park Conservancy makes the decision to cancel programming. Parents will be contacted via email or phone. Contact Yvette Bass at 313-264-1414 if you are unsure about inclement weather day plans.
 
LATE PICK-UP: Chandler Park will not offer a “latchkey” program. It is vital to the integrity of the program that children are dropped-off and picked-up on time!
 
RESPECT THE OFFICIALS:  While it may be easy to second-guess your child’s coach from the sidelines, most parents forget or overlook how challenging it is for coaches to manage multiple kids who are all at multiple skill levels.  The job of being a coach is an incredibly difficult task so be sure to support the CP SPY coaches as much as possible.  If you have an issue with a coach please contact program directors Yvette Bass at 313.264.1414 / yvettejoy.cpc@gmail.com or Liam McIlroy at 313.802.0136 / liammcilroy3@gmail.com.
 
REFRAIN FROM THREATENING LANGUAGE OR PHYSICAL AGGRESSION: There is never a place in youth sports to use vulgarities, threaten, intimidate, or use physical aggression.  Also be aware of the language you may use while on the phone during a program session.  If you have to take a call that might get heated, please step away for the practice area; often times we can get wrapped up in a conversation and lose track of the environment we are in.  Any physical or verbal aggression against DYLA coaches, participants, staff, or other parents will not be tolerated.  Anyone found guilty of verbal/physical aggression during program hours will promptly be asked to leave the park and their child may unfortunately be removed from the program.  
 
WATCH FOR THE SAFETY OF ALL PLAYERS AT ALL TIMES: Be sure to pay attention to injuries, including concussions, and respond to them in a timely manner.  Additionally, pay attention to signs of youth sport burnout and be sure to respond to your child if they need help.  Please feel free to speak with coaches or program staff if you feel your child’s emotional or physical well-being is being compromised.
Parent Information Sheet
Liability Form
IN CONSIDERATION OF my minor child/ward as listed below in this form (“My Child”), being allowed to participate in any way in this Chandler Park program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
 
1.     The risk of injury to My Child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and
2.     I, for myself, my spouse, My Child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, Chandler Park, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to My Child’s involvement or participation in this program, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and
3.     FOR MYSELF, MY SPOUSE, AND MY CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for My Child’s participation; and
4.     I, for myself, my spouse, My Child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to My Child’s involvement or participation in these programs, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted by law; and
5.     I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in My Child’s readiness for participation and/or in the program itself, I will remove My Child from participation in the program and bring such to the attention of the nearest official immediately; and
6.     I grant Chandler Park Conservancy, and its trustees, advisors, staff, volunteers, agents, successors, licensees, and assigns, the irrevocable right and license to use videography, audio, and photography, to edit or crop photographs, and to use or authorize the use of such audio, videography, or photography or any portion of them in any manner or media at any time in perpetuity, and to use My Child’s name, likeness, biographical or other information concerning him/her in connection therewith, including promotion in all media. I agree to hold Chandler Park Conservancy harmless against any liability, loss, or damage resulting from the use of My Child’s photographs, and I hereby release and discharge Chandler Park Conservancy and its trustees, advisors, staff, volunteers, sponsors, agents, successors, licensees, and assigns from any and all claims in connection with such use of photographs; and
7.     If I am unable to provide transportation for My Child, I give permission for My Child to be driven by Chandler Park Conservancy and its staff and/or volunteers, including parents of participants. I assume full responsibility and I hold harmless Chandler Park Conservancy and its trustees, advisors, staff and volunteers from any and all claims related to such transportation.
8.     Chandler Park Conservancy and its partners offer surveys to youth and to parents. I consent for CPC to use survey information for the improvement of programs and for reporting aggregate information about programs, coaches, parents, and youth.
 
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Child's Name *
Parent Guardian Signature(s) *
Date *
MM
/
DD
/
YYYY
Print Name *
Certification of Child’s Fitness and Medical Authorization
I hereby certify that to the best of my knowledge, My Child is physically fit and able to safely participate in the sports activity for which he/she has been registered.
Parent/Guardian Signature(s) *
Date *
MM
/
DD
/
YYYY
Print Name *
Hard Copy of Liability Form (for your reference, NO need print/fill out and submit)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Denison University. Report Abuse