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Registration fees for the 2013-2014 season are $325
You will be prompted to make payment once you submit this form.
Player Information
Player Last Name
*
Player First Name
*
Date of Birth
*
Home Address
*
City
*
Zip Code
*
Home Phone
*
Player Email
Grade
*
8
7
6
5
School Name
*
US Lacrosse #
*
US Lax Exp. Date
*
On Facebook
Yes
No
Player Cell Phone
Cell Provider
Verizon
AT&T
Sprint
Other
Other
Text Msg
Yes
No
Player Unifom Info
Jersey
*
Adult Small
Adult Medium
Adult Large
Adult Xtra Large
Shorts
*
Adult Small
Adult Medium
Adult Large
Adult Xtra Large
T-shirt
*
Adult Small
Adult Medium
Adult Large
Adult Xtra Large
Parent/Guardian Info
Relation to Player
*
Parent/Guardian 1 Last Name
*
Parent/Guardian 1 First Name
*
Parent/Guardian 1 Home Phone
*
Parent/Guardian 1 Cell Phone
*
Phone Provider
*
Verizon
AT&T
Sprint
Other
Other
TXT MSG
Yes
No
Parent/Guardian 1 Work Phone
*
Parent Guardian 1 Preferred Email
*
Relation to Player
Parent/Guardian 2 Last Name
Parent/Guardian 2 First Name
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Cell Phone
Phone Provider
Verizon
AT&T
Sprint
Other
Other
TXT MSG
Yes
No
Parent/Guardian 2 Work Phone
Parent Guardian 2 Preferred Email
Medical Insurance Info
Player's Doctor's Name
*
Doctor's Phone Number
*
Insured's Name
*
Group #
*
Policy #
*
Insurance Company
*
Insurance Address
*
Insurance Phone Number
*
Online Payment
*
2013-2014 MS Registration Fee ($325.00)
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