Grade 5-6 Registration(hidden)

GRADE 5-6 SPRING 2017 REGISTRATION

Please fill out the registration form below and click on the 'SEND MESSAGE' button at the bottom of the page.

In order to complete the form, you will need a current US Lacrosse Number and expiration date.

To register for a US Lacrosse number or renew your membership, please go to

www.uslacrosse.org

-Click on the membership link and select join/renew.

There is a $25 fee associated with registration that you pay directly to US Lacrosse Association.

Name*

Grade*

Grade 5Grade 6

School*

Birthday*

E-mail address*

Street Address*

City/ Zip*

Primary Phone Number*

Additional Phone Number

Health Insurance Carrier*

Insurance Policy/ ID Number*

Emergency Contact Name*

Emergency Contact Number*

Relationship to Player*

Does your player have any medical conditions we should be made aware of?

Have you played lacrosse before? If so, how many years?*

US Lacrosse Number:*

US Lacrosse Expiration Date:*

Do you currently have a UNIFORM JERSEY and SKORT?*

Uniform Shirt Size: (Please fill out ONLY if you are NEW or can exchange a JERSEY from last year)

Uniform Skort Size: (Please fill out ONLY if you are NEW or can exchange a skort from last year)

I verify that my child is physically able to fully participate in the Warwick Girls Lacrosse Club Spring 2017 League. I agree to assume all risks resulting from my child's participation in the Spring 2017 LAGLA League and Warwick Girls Lacrosse Club. I further agree that the Warwick Girls Lacrosse Parents Club, coaches or volunteers shall not be liable for any injury, harm or illness resulting from my child's involvement in the program. I understand in the event of a medical emergency I will be notified as soon as possible. I understand my child will receive first aid and medical attention at the discretion of the coaches and staff. I hereby give my permission for my child to be transported by EMS to the nearest hospital in the event of an accident. Parent, please add your name below:*

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Thank you for registering for the Spring 2016 LAX Season! Please remember to go the the PAYMENT page to complete the registration process.