Clubs Sports


Join Womens Lacrosse Club


Medical Insurance


First time users- you must fill the Membership Form before proceeding to other forms
Returning users- Login to your Club Sports account and use previously submitted details

*Incomplete Form

Do you have medical insurance?

Emergency Contact Name:

Emergency Contact Phone :

Allergies/Medications/Medical Conditions:

If you have insurance:

Insurance Company :

Policy Holder Name:

Policy # :

Group # :

I verify that all the information given on this form is current and correct to the best of my knowledge.I authorize Cal Poly State University to notify my parents/guardians in case of an emergency.

If you don't have insurance:

In exchange for participation in Cal Poly’s Club Sports Program, I accept all financial responsibility for any and all medical expenses that I may incur as a result of participation in the program. Further, in exchange for participation in the Cal Poly Club Sports Program, for myself, and for my heirs, executors, legal representative, successors and assign, I hereby waive all claims and/or courses of action, including negligence, against the State of California, the Trustees of the California State University, California Polytechnic State University and all of their officers, directors, employees and agents, arising out of, or in any way connected with, my participation in the aforementioned program. 'Participation' includes, but is not limited to, travel to and from the activity. I verify that all the information given on this form is current and correct to the best of my knowledge.