Registration

Team Name (required)

First Name (required)

Last Name (required)

Players Email (required)

Players Cell (required)

Address (required)

City (required)

State (required)
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip (required)

Date of Birth (required)

School (required)

Age (required)

Grad Year (required)

US Lacrosse Membership Number (required) If you don’t have a US Lacrosse Membership, please visit this link to purchase one. https://uslacrosse.org/membership

US Lacrosse Membership Expiration Date (required)

Position (required)
—Please choose an option—AMDGFOGOSSDMLSM

Dominate Hand (required)
—Please choose an option—RightLeft

Club Coaches Name (required)

Club Coaches Email (required)

Club Coaches Cell (required)

HS Coaches Name (required)

HS Coaches Email (required)

HS Coaches Cell (required)

Primary Guardian

Father Name

Mother Name

Primary Email (required)

Primary cell (required)

Health INS Provider

Health INS #

I AGREE and have read and understand the event waiver (required)

Signature of Parent / Guardian (required)

Date of Signature (required)