Fastbreak Lax    4401 Cottington Rd    Baltimore, MD 21236 (office)

410-931-2331 office        410-931-2886  fax        e-mail:  fastbreaklax@comcast.net

APPLICATION FORM FOLLOWS THIS INFORMATION.

Fastbreak Lax is now signing up individual high school players to participate in the "Boys' High School Teams Program."  You must be in high school during the 2008-09 school year or must be 14 years old by October 18, 2008.  Exceptions to the age policy must be approved by the program commissioner.  A person can not play at our indoor JV level if he has already played varsity at his respective school.  Also, JV players cannot be in grades 11 or 12 during the 2008-09 school year.  If you do not already belong to an established team but would like to play indoor lacrosse, you may sign up as an individual and then be placed in a "player pool."  Sorry - no beginners.  From this pool, at-large teams will be formed to compete against already established teams.  Talent level will be matched up as closely as possible against the other teams.  You may request to be placed on the same team as other individuals by writing their names at the bottom of the application. 

GAME SITE:  Freestate Indoor Sports Arena, 5811 Allender Rd, White Marsh, MD 21162.  Arena phone is 410-335-6400.  For more information about the facility, visit their web site at www.freestatesports.com.

DIRECTIONS:  From the Baltimore Beltway (I 695), take Exit 33 onto I 95 North (Kennedy Hwy).  Get off at Exit 67 A and proceed EAST on Route 43 (White Marsh Blvd) about 2/3 of a mile to Route 40 EAST (Pulaski Hwy).  Go about 1 and 1/2 miles EAST on Pulaski Hwy to Allender Rd (second traffic light) and turn left.  Go 1/8 of a mile.  The arena is on your left.

FEE is $ 150.00.  Make your check payable to FASTBREAK LAX and mail the application and payment to:   Fastbreak Lax, 4401 Cottington Rd, Baltimore, MD 21236.  Deadline for receiving your application is Monday, October 6, 2008.  To pay by credit card, see application below.

GAME DATES:  Go to Boys "PROGRAM INFORMATION" link for specific dates.

EQUIPMENT:  Fastbreak Lax will NOT supply equipment.  Required - mouth guard, gloves (no cut out fingers or palms), short sticks only, safety-approved helmet, arm pads, turf shoes (NO football cleats), and shoulder pads.  Fastbreak Lax WILL provide jerseys for our at-large teams. We highly recommend rib pads and athletic cup.  Goalies need to wear gloves, safety-approved helmet, chest protector, throat guard, turf shoes (NO football cleats), and athletic cup.  There are no requirements on the type of goalie stick, and arm and shoulder pads are optional but highly recommended.

ON-THE-FIELD:  Five line players and a goalie.  Players run both ends of the field (like basketball) and sub on-the-fly, during timeouts, and between periods.  Games run two 20-minute periods.

ADDITIONAL INFORMATION:

1.  We stress safety at all times.  Two professional officials referee each game.  Outdoor rules are employed when possible, and we use regulation lacrosse balls and 6' by 6' goals.      2.  There will NOT be slamming of players into the walls, no cross-checking, no uncontrolled stick checks, no body checks other than squaring up on your opponent, and no unsportsmanlike conduct by players, coaches, and spectators.      3.  There is a professional trainer and paid score keeper at all games.      4.  No alcoholic beverages will be allowed at games by anyone.      5.  Schedules will be given out at your practice in late October.  We will also post the schedule on this web site under "Boys High School Teams Program."      6.  Freestate Arena has a snack bar, rest rooms, and vending machines.      7.  You will be contacted around early-to-mid October about your team and the date/time of practice.

FOR FURTHER QUESTIONS, CONTACT PROGRAM COMMISSIONER CHAD ROEDER AT 410-931-2331 or at fastbreaklax@comcast.net.

APPLICATION FORM

INDIVIDUAL  -  BOYS' HIGH SCHOOL INDOOR LACROSSE PROGRAM 2008-09

NAME (print) ___________________________    SCHOOL _____________________ GRADE ___

ADDRESS _____________________________   CITY/TOWN ____________________    ZIP _____

PHONE (include area code) ________________    E-MAIL ________________________________

BIRTH DATE ___________________    AGE ____      HEIGHT ______        WEIGHT ______

FIELD LACROSSE EXPERIENCE (circle)    GOAL        DEF        ATK        OFF MIDDIE        DEF MIDDIE        POLE

MOST ADVANCED EXPERIENCE (X)              REC ___    FRESH/SOPH ___    JV ___    VARSITY ___

                                                                    STARTER ____    2nd STRING ____    3rd STRING ____

EMERGENCY CONTACT PERSON ________________________    PHONE __________________

LEAGUE AGREEMENT (to be read and signed by your parent or legal guardian)

I agree NOT to hold Fastbreak Lax, Inc, the Boys' High School Indoor Lacrosse Program, Fastbreak Lax personnel, and its coaches responsible for any injury to my son/ward while playing in this indoor lacrosse program.  I further agree that my son/ward is in good physical health and is fit to play indoor lacrosse.  I also understand that this is a contact sport, and that my son/ward must wear the necessary and correct protective equipment to prevent serious injury.  I am aware that Fastbreak Lax, Inc. and The Freestate Indoor Sports Arena do NOT provide health insurance for players.  In the event of an injury to my son/ward, any payment for medical attention is my responsibility.

PARENT/GUARDIAN SIGNATURE: _______________________________    DATE: _____ / ____ / ____

If paying by check, make it payable to "FASTBREAK LAX" in the amount of $ 150.00 and mail this completed application with your check to Fastbreak Lax, 4401 Cottington Rd, Baltimore, MD 21236.

If paying by credit card, fill out the following and mail this completed application to Fastbreak Lax, 4401 Cottington Rd, Baltimore, MD 21236.  Your credit card information will remain confidential.

Print the Name as it appears on the Credit Card: ______________________________________

Choose One (circle):    Mastercard      Visa        Credit Card Number ________________________

Expiration Date: ____________________    Amount: ________________

Address of Cardholder: ____________________________________________  Zip __________

Signature of Cardholder: _________________________    Date ____ / ____ / ____