2021 Fall Registration

Athlete's First Name *

Athlete's Last Name *

Athlete's Cell Phone *

Athlete's Email Address *

Athlete's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Cell *

Parent/Guardian Address (if different from yours)

Address Line 1

Address Line 2

City

State

Zip Code

Do you Wish to add a second Parent/Guardian Information?

Health Insurance Provider *

Health Insurance Policy Number *

US Lacrosse Number *

If you don't know your US Lacrosse Number you can visit US Lacrosse Membership Lookup

Date of Birth *//

School Name *

Graduation Year *

Try Out Date *

Cost

Returning player: $445 with Jersey

Returning player: $495 without Jersey

New Player: $525

Payment to be discussed with Coach