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Lacrosse Training For Urban San Diego
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06/06 Summer Kickoff 619 Positional Training EVENING CLINIC Registration
Register Here to Join Us on
The Evening
of June 6th!
Spots are limited, so be sure to sign up ASAP to reserve your spot now!
Last Name
(required)
First Name
(required)
Player’s Email:
(required)
Player’s Current Age:
(required)
DOB: DD/MM/YYYY
(required)
Boys or Girls
Boys
Girls
Rising Class? (as of July 1st 2026)
Rising 7th
Rising 8th
Rising 9th
Rising 10th
Rising 11th
Rising 12th
Name of School or Club Program:
(required)
Name of School District:
(required)
Parent/Guardian Infor
mation
Parent’s First Name:
(required)
Parent’s Last Name:
(required)
Parent’s Email:
(required)
Parent Cell Phone:
(required)
Street Address:
(required)
City
(required)
State
(required)
Zip Code:
(required)
Additional Parent First Name:
Additional Parent Last Name:
Additional Parent E-Mail:
Additional Parent Phone:
Emergency Contact Name:
(required)
Emergency Contact Phone Number:
(required)
Emergency Contact Relationship to Player:
Additional Player Information
Primary Position
(required)
Attack
Offensive Midfield
Short Stick Defensive Midfield
Long Stick Midfield
Defense
Goaltender
Not Sure / Never Played
Player Skill Level (Choose one)
(required)
Beginner (0 to 2 Years Experience)
Intermediate (2 to 3 Years Experience)
Advanced (3+ Years Experience)
Equipment Size
(required)
Adult XL/XXL
Adult L/XL
Adult M/LG
Youth L/XL
Apparel Size (Tops)
(required)
Adult XL/XXL
Adult L/XL
Adult M/LG
Youth L/XL
Apparel Size (Bottoms)
(required)
Adult XL/XXL
Adult L/XL
Adult M/LG
Youth L/XL
Player Medical Information
Allergies (if yes please list)
(required)
Other Medical Conditions (if yes please list)
(required)
Medications (if yes please list)
(required)
Medical/Hospital Insurance Company
(required)
How did you hear about us?
(required)
Search Engine
Social Media
Coach's Referral
Friend or Family
LIABILITY WAIVER
(required)
By proceeding with registration, I hereby request that the child named above herein be admitted to the 619 Lacrosse Camp and give my permission for him/her to participate in the camp training regimen, which I realize as a physical activity can result in injury. I hereby waive all claims to liability to the directors, coaches, staff, and Camp/Facilities Organizer (619 Lacrosse) and authorize the directors to act for me according to their best judgments in any emergency requiring medical attention for services other than the accident insurance maintained by the camp, I will pay. All camp insurance policies must be followed exactly in order to receive coverage.
Please further acknowledge by signing your Name
(required)
PHOTOGRAPHS/VIDEOS/SOCIAL MEDIA WAIVER
I hereby further authorize 619 Lacrosse Camp to take photographs and videotape of my child while participating in any 619 Lacrosse activities. By checking this box, I authorize 619 Lacrosse.com to use any of the above for promotional purposes and promotional purposes only.
ASSUMPTION OF RISK:
(required)
In exchange for the right for the Player to participate in the 619 Lacrosse Programs, I hereby assume all risks associated with lacrosse, including the RISK OF SERIOUS BODILY INJURY, DEATH and/or PROPERTY DAMAGE and the negligence of 619 Lacrosse, and I hereby agree NOT TO SUE 619 Lacrosse, nor their sponsors, directors, officers, employees, coaches, volunteers, instructors, agents, partners, sponsors, nor any of their affiliates (“619 Lacrosse Parties”) and I release the 619 Lacrosse Parties from any and all liability, claims or demands of every kind and nature whatsoever which may arise out of the Player’s participation in activities arranged by 619 Lacrosse. I agree NOT TO SUE and I release the 619 Lacrosse Parties and fully accept the risk of any illness or injury suffered by the Player while taking part in the 619 Lacrosse Programs (including injuries that might cause death), including the ones listed above and other injuries common to contact sports and injuries (including injuries that might cause death) that may arise during travel associated with the 619 Lacrosse Programs. I release the 619 Lacrosse Parties and fully accept the risk of any damage to property arising out of the 619 Lacrosse Programs. This release will serve as a release and assumption of risk which binds my heirs, executors, and administrators, and for all members of my family
PARENTAL/GUARDIAN CONSENT:
(required)
As a parent/guardian, I give my child permission to participate in the 619 Lacrosse Camp programs and activities, and I release 619Lacrosse.com, employees, or agents, from any responsibility and or liability regarding any injury resulting from participating in any and all of the programs 619 Lacrosse offers. I further agree to inform my child that he/she must follow all safety rules, policies, and procedures as instructed with regard to the 619Lacrosse.com programs he/she is now attending or will attend in the future. By signing this form, I acknowledge that I have read and understand its contents and voluntarily choose to permit my child to participate in the activities described above.
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