Insurance Waiver – UNDER the Age of Majority

Sign and Submit with Registration Form
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
BY SIGNING THIS, YOU WILL WAIVE CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO SUE.
PLEASE READ CAREFULLY.

Box Registration.
1. Fill out the pdf Registration form on-line.
2. Print and sign 3 copies to bring with you when you register along with;

• proof of residency
• birth certificate
• medical card for your child
• two cheques payable to the PCMLA (Registration / Uniform Deposit)

or mail to:

PCMLA Registrar
c/o Poco Minor Lacrosse

2133 – 2850 Shaughnessy Street
Box 214
Port Coquitlam, BC V3C 6K5

Please Note: The free Acrobat Reader does not allow you to save a completed, or a partially completed form on your computer.

Male Field Registration Season.

1. Fill out the pdf Registration form on-line.
2. Print and sign 3 copies to bring with you when you register along with;

• proof of residency
• birth certificate
• medical card for your child
• two cheques payable to the PCMLA (Registration / Uniform Deposit)

or mail to:

PCMLA Registrar
c/o Poco Minor Lacrosse

2133 – 2850 Shaughnessy Street
Box 214
Port Coquitlam, BC V3C 6K5

You will need Adobe Acrobat Reader 5.0 (or later).  Download newest Acrobat Reader: http://www.adobe.com/products/acrobat/readstep.html.

Click on the hyperlinked form title or Acrobat Reader icon.  A dialogue box opens allowing you to (a) Save the pdf to your hard drive for later viewing or (b) open the form in Acrobat Reader within your browse for viewing now.

You can display all form fields by clicking on the ‘highlight fields’ button at the top right of the page. Click on a from field, type in your information. Use the tab key to move to the next field. After completing the form, please print (3) copies, all signatures must be hand signed on the form.

Please Note: The free Acrobat Reader does not allow you to save a completed, or a partially completed form on your computer.

To request a Player Release;

This form must be included with your Player Registration form.
Please download, print, fill-in and submit with your registration form.

Why do I need a Player Release Request Form?

The request for a release of a player is when;

1. the association you reside in cannot accommodate your child’s division (eg: your child should be in the U10 division and due to low numbers there is no division).
2. or the division that your child should play at has reached it’s limit – (eg:  U14 – capped at 40).

Please contact the PCMLA Registrar or the PCMLA President if you have any questions.

PCMLA Registrar: Linda Wiseman

	registrar@pocominorlacrosse.com
	604-942-2806

Head of Field: Derek Milani

	headcoach@pocominorlacrosse.com
	604-942-9774