2018 Fall Ball Registration
Registration, Release & Waiver of Liability and current US Lacrosse membership are required. You are considered a Germantown Resident if you live in zip codes 38138 or 38139
US Lacrosse # Instructions
All participants must be members of US Lacrosse. You can register online at www.uslacrosse.org . Players will not be eligible to play unless they have a current US Lacrosse membership number.
Waiver and Release
I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, my heirs, and personal representatives, that Houston Lacrosse Club, Germantown Municipal School District, the city of Germantown, US Lacrosse, and sponsors of any Houston Lacrosse Club recognized or sanctioned event, along with coaches, officials, referees, umpires, volunteers, employees, agents, officers and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event. I acknowledge that Houston Lacrosse Club is not part of Houston High School, The Germantown Municipal School District, the City of Germantown or Germantown Parks and Recreation Department.
Assumption of Risk and Release for Activities Held on Property of the Germantown Municipal Schools Board Of Education
In consideration of my child/ward being permitted to participate in the Athletic/Activity Program conducted by the Houston Lacrosse Club at a GMSD facility
I, as parent and guardian of the participating child, do hereby agree to assume all the risks and responsibilities relative thereto.
I hereby represent to the Germantown Municipal School District that the child is capable of participating in this activity and understand that participants are strongly encouraged to consult a physician prior to any participation.
I hereby recognize the risks of illness and injury inherent in any activity based program, and the child, my heirs, and personal representatives agree to defend, hold harmless, indemnify, release and forever discharge Germantown Municipal School District, its respective officers, agents, representatives and employees from and against any and all rights, claims, demands, and actions or causes of action, including attorney’s fees and court costs on account of damage to personal property, personal injury, or death which may result from the child’s participation in this athletic/activity program
By my signature below, I hereby confirm my understanding of this release statement holding the Germantown Municipal School District harmless, and acknowledge that they do not carry health and accident insurance to cover participants of the program and that participants are strongly encouraged to obtain full insurance coverage prior to participation in the Program.
I hereby give my consent to the Houston Lacrosse Club to post photos of my child taken during Houston Lacrosse Club activities on the Houston Lacrosse Club websites. I understand that photos will not have any identifying information of any child.
I hereby give my consent to Houston Lacrosse Club and the host organization of any Houston Lacrosse Club recognized or sanctioned event to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my participation in Houston Lacrosse Club recognized or sanctioned events.
Player Code of Conduct
The Houston Lacrosse Club (HLC) and coaches
believe the highest potential of sports is achieved when players and coaches are committed to
pursuing victory with honor according to a code framed by three core principles: Responsibility,
Respect, and Sportsmanship. This code was developed with the intent of providing a clear set of
expectations and rules for all players, parents/guardians and coaches.
The “Code of Conduct” relates to player actions on and off the field. It is broad in its reach and
violations are generally defined as any action deemed detrimental to the player, team,
and/or HLC. Examples include poor grades, school suspension, illegal activity, bullying,
inappropriate posts via multimedia, etc. Violations will result in disciplinary action as
determined by the coaching staff.
This code of conduct is a minimum standard for all teams and players within the HLC. Coaches can add additional rules and penalties
or expound existing rules. Coaches will be responsible for
determining any offense to this code and assign the disciplinary action according to the
Academics – be a student first and commit to getting the best education possible. A player who
has a failing semester grade or has a cumulative average below a 2.0 will be suspended from the
team until his/her grades are shown to improve.
Games/Practices – All players or a parent/guardian are expected to call a coach or the club
president IN ADVANCE of missing a game or practice. You are encouraged to follow up with
an email. Absence or tardiness without notice will result in disciplinary action as determined by
the coaching staff.
Attitude – Throwing and/or abuse of equipment is prohibited regardless of ownership. Players
will sprint to and from their positions during games, timeouts, practice, etc. Violations will
result in disciplinary action as determined by the coaching staff,
Team – HLC promotes the team concept and believes “the team comes first.” Promote the wellbeing
of teammates by supporting and encouraging them. Hazing, harassment, or intimidation of
a teammate will not be tolerated. Coaches and players will know that every single player matters
in a winning program.
Coaches – Respect the coaches by listening and following instructions during practice and
games without comment. A lack of respect from a player will result in disciplinary action as
determined by the coaching staff. Repeated offenses will result in
suspension or dismissal from the team. Problems with game plans, strategy, positioning, etc. are
to be managed outside of practices and games. Coaches will treat all players with dignity and
honor. Coaches will not belittle, degrade, or use obscene language when speaking to a player.
Game Officials – Players will not complain or argue calls with an official during a game. Only
the coach or team captain can initiate conversation with a referee. If an issue arises during the
game that requires attention from the officials, that information MUST come from the coaching
staff. Violation by a player will result in disciplinary action as determined by the coaching staff.
Violation by a parent or spectator can result in removal from the game site.
Opponents – Players will not engage in any disrespectful conduct toward our opponents. You
will not use profanity, obscene gestures, or taunt them at any time. Foul language on or off the
field is prohibited. Violation will result in disciplinary action as determined by the coaching
Illegal Activity – Conviction of a criminal offense will result in disciplinary action as determined
by the coaching staff. Traffic tickets are excluded. Theft of any kind will
not be tolerated and will result in disciplinary action. Applicable city curfews will be followed
by all players, especially on nights prior to competition.
Drugs/Alcohol – Do not use any illegal or unhealthy substances to include drugs, steroids,
alcohol, and tobacco. At a minimum, a player who is caught using
drugs, alcohol, or tobacco at a team practice, game, weekend tournament or function will be
dismissed from the team for the remainder of the season. The purchase, distribution, or use of
alcohol or any other drug (at any time) by a player without the written consent of a licensed,
practicing physician is prohibited. Violation will result in disciplinary action as
determined by the coaching staff.
Social Media – Inappropriate texts, posts, reposts, emails, pictures, phone calls, tweets, retweets,
etc. via any form of social media (existing or created after the date of this document) is
prohibited. Violation will result in disciplinary action as determined by the coaching staff.
Travel – When games are played outside of our Region, all players must be driven by their
parent/guardian, member of the coaching staff or other parent/adult. Exceptions must be granted
in advance with notice given to all coaches.
For hotel/motel stays, players are expected to follow the hotel rules. Room assignments for
players will be designated by the coaching staff or club president. Any damage to a room is the
financial responsibility of the player(s) and her parent/guardian.
Players and Parents will be given an opportunity to discuss major disciplinary action with the coach. The following is a list to include but not limited to disciplinary actions that can be implemented by the coach at the coach’s discretion:
Removal from practice
Removal from games
Removal from starting line up
Partial game suspension
Full game suspension
Dismissal from team
Any combination from above
Parent Code of Conduct
As a parent involved in the Houston Lacrosse Club (HLC), I hereby pledge to provide positive support,
care, and encouragement for my child participating in this program by following this Parent’s Code of
Conduct and Ethics.
I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and
officials at every game, practice, or other Houston event.
I will not engage in any kind of unsportsmanlike conduct with any official, coach, player, or parent such as
booing and taunting; refusing to shake hands; or using profane language or gestures.
I will not discuss penalties, rulings, lack of action, etc. with any game official before or after a
I will never ridicule or yell at my child or other participant for making a mistake or losing a competition.
I will support coaches and officials working with my child, in order to encourage a positive and enjoyable
experience for all.
I understand that my child is an essential part of the team and I will make every reasonable effort,
including ride-sharing or car-pooling, to insure my child is on-time to all practices and games per the
I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol and will
refrain from their use at all Houston events.
I will remember that the game is for youth – not adults.
I will demand that my child treat other players, coaches, fans and officials with respect regardless of race,
sex, creed or ability.
I will help my child enjoy the Houston Lacrosse experience by doing whatever I can, such as being a
respectful fan, assisting with any volunteer requests/needs, or providing transportation.
I understand that many coaches and all club officers and board members are unpaid volunteers who are
donating their time for the benefit of the players, parents and community.
I understand that sideline access is restricted to players, coaches, trainers and stat/scorekeepers. The only
exception would be to assist in the injury/health of a player.
I understand that parents are restricted from entering the field of play for any reason, including injuries,
unless called upon by a referee, coach, trainer or scorekeeper. No exceptions.
I understand that HLC has approved a policy stating that any parent ejected from a game or acting
inappropriately before or after a game will be expelled from Houston Lacrosse Club with no refund
of fees and no opportunity to return in the current or future seasons. If expelled, that parent’s
child/player is also expelled from the program.
I agree to abide by the Parents’ Code of Conduct and Ethics. If I do not live up to the Parents’ Code of
Conduct and Ethics, I understand and accept that I will be subject to disciplinary action that could include,
but is not limited to the following:
1. Verbal warning by official, scorekeeper, game/sideline manager, coach, HLC Officer or HLC Board
2. Parent and their child/player ejection from field or gym
3. Parent and their child/player game(s) suspension
4. Parent and their child/player expulsion from HLC with no refund of fees
Additional Parental Expectations & Information
The Houston Lacrosse Club supports the academic endeavors of our players. If a parent determines that a
player is not maintaining proper academic standards, said parent should discuss any potential
repercussions involving lacrosse with the appropriate head coach.
Removal of playing time for violations of the Player Code of Conduct off the field should be discussed
between parents and the head coach. However, if unruly behavior occurs on the field, then coaches have
the ability to enforce immediate removal of playing time for the overall benefit of the entire team.
Players on all teams should expect to play in the positions that most benefit the team and the players’
Playing hard is to be enforced with positive re-enforcement.
Negative re-enforcement will be kept to a minimum.
Only the Head Coach can speak with the Referee.
At no time should any parent be aggressive with other players/families, coaches, board members or
All parents should be supportive and respectful of all coaches especially when players are present.
Coaches will provide clear expectations for players for practices and games. If a parent has questions or
concerns, said parent agrees to follow the Houston Women’s Lacrosse Grievance Policy, which dictates
that the parents must initially discuss the issue with the head coach and a club officer before pursuing
further action. The full Grievance Policy is listed below.
If a parent or member has a complaint, the first step is to discuss the problem with the Head Coach and a
club officer at an appropriate time. Acceptable times are those agreed upon by all parties. Parent/Coach
conferences will not be allowed before a game, during a game or during a practice. Playing time, player
positions, substitutions and game strategy are the coach’s decision and are not valid grievances. These
topics are not open for discussion.
If this does not satisfy the parent’s complaint, a meeting will be held with the coaching staff, the parents, a
club officer and an HLC board member that does not have a child on the team in question. The HLC
board member shall act as an arbitrator, if required and/or requested to do so. Should the offended party
not be satisfied after this meeting, a formal complaint must be presented in writing to the HLC board of
directors for further action.
INFORMATION AND SIGNATURE FORM
FOR STUDENT-ATHLETES & PARENTS/LEGAL GUARDIANS
(Adapted from CDC “Heads Up Concussion in Youth Sports”)
Public Chapter 148, effective January 1, 2014, requires that school and community organizations sponsoring youth athletic activities establish guidelines to inform and educate coaches, youth athletes and other adults involved in youth athletics about the nature, risk and symptoms of concussion/head injury.
Read and keep this page.
Sign and return the signature page.
A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow or jolt to the head or body that causes the head and brain to move rapidly back and forth. Even a “ding,” “getting your bell rung” or what seems to be a mild bump or blow to the head can be serious.
Did You Know?
• Most concussions occur without loss of consciousness.
• Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion.
• Young children and teens are more likely to get a concussion and take longer to recover than adults.
WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?
Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury.
If an athlete reports one or more symptoms of concussion listed below after a bump, blow or jolt to the head or body, s/he should be kept out of play the day of the injury and until a health care provider* says s/he is symptom-free and it’s OK to return to play.
SIGNS OBSERVED BY COACHING STAFF
SYMPTOMS REPORTED BY ATHLETES
Appears dazed or stunned
Headache or “pressure” in head
Is confused about assignment or position
Nausea or vomiting
Forgets an instruction
Balance problems or dizziness
Is unsure of game, score or opponent
Double or blurry vision
Sensitivity to light
Answers questions slowly
Sensitivity to noise
Loses consciousness, even briefly
Feeling sluggish, hazy, foggy or groggy
Shows mood, behavior or personality changes
Concentration or memory problems
Can’t recall events prior to hit or fall
Can’t recall events after hit or fall
Just not “feeling right” or “feeling down”
Health care provider means a Tennessee licensed medical doctor, osteopathic physician or a clinical neuropsychologist with concussion training
CONCUSSION DANGER SIGNS
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. An athlete should receive immediate medical attention after a bump, blow or jolt to the head or body if s/he exhibits any of the following danger signs:
• One pupil larger than the other
• Is drowsy or cannot be awakened
• A headache that not only does not diminish, but gets worse
• Weakness, numbness or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Cannot recognize people or places
• Becomes increasingly confused, restless or agitated
• Has unusual behavior
• Loses consciousness (even a brief loss of consciousness should be taken seriously)
WHY SHOULD AN ATHLETE REPORT HIS OR HER SYMPTOMS?
If an athlete has a concussion, his/her brain needs time to heal. While an athlete’s brain is still healing, s/he is much more likely to have another concussion. Repeat concussions can increase the time it takes to recover. In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to their brains. They can even be fatal.
Concussions affect people differently.
While most athletes with a concussion
recover quickly and fully, some will
have symptoms that last for days, or
even weeks. A more serious
concussion can last for months or
WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A CONCUSSION?
If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention. Do not try to judge the severity of the injury yourself. Keep the athlete out of play the day of the injury and until a health care provider says s/he is symptom-free and it’s OK to return to play.
Rest is key to helping an athlete recover from a concussion. Exercising or activities that involve a lot of concentration such as studying, working on the computer or playing video games may cause concussion symptoms to reappear or get worse. After a concussion, returning to sports and school is a gradual process that should be carefully managed and monitored by a health care professional.
* Health care provider means a Tennessee licensed medical doctor, osteopathic physician or a clinical neuropsychologist with concussion training.
Student-athlete & Parent/Legal Guardian Concussion Statement
Must be signed and returned to school or community youth athletic activity prior to participation in practice or play.
Student-Athlete Name: _________________________________________________________
Parent/Legal Guardian Name(s): _________________________________________________
After reading the information sheet, I am aware of the following information:
Parent/Legal Guardian initials
A concussion is a brain injury which should be reported to my parents, my coach(es) or a medical professional if one is available.
A concussion cannot be “seen.” Some symptoms might be present right away. Other symptoms can show up hours or days after an injury.
I will tell my parents, my coach and/or a medical professional about my injuries and illnesses.
I will not return to play in a game or practice if a hit to my head or body causes any concussion-related symptoms.
I will/my child will need written permission from a health care provider* to return to play or practice after a concussion.
Most concussions take days or weeks to get better. A more serious concussion can last for months or longer.
After a bump, blow or jolt to the head or body an athlete should receive immediate medical attention if there are any danger signs such as loss of consciousness, repeated vomiting or a headache that gets worse.
After a concussion, the brain needs time to heal. I understand that I am/my child is much more likely to have another concussion or more serious brain injury if return to play or practice occurs before the concussion symptoms go away.
Sometimes repeat concussion can cause serious and long-lasting problems and even death.
I have read the concussion symptoms on the Concussion Information Sheet.
* Health care provider means a Tennessee licensed medical doctor, osteopathic physician or a clinical
For any Participant who is not yet 18 years old
As legal guardian of this participant, I hereby verify by my signature below that I have read and fully understand each of the above conditions for permitting my child to participate in any Houston Lacrosse Club recognized or sanctioned event, and I accept each of the above conditions, especially the waiver and release set forth in paragraph one.