"*" indicates required fields If your player(s) are current USA Lacrosse Members, please provide their member id. If they are not members, there is an additional $7.50 insurance fee per player. This fee allows the player to be covered for any additional clinics we hold for the next year. * This does not include the PAL Spring Season (a USA Lacrosse Membership is required for our PAL Season. For information the benefit of USA Lacrosse Membership - please visit https://www.usalacrosse.com/membershipChild Name (1st Player)* First Last Players Grade (1st Player)*Grade player is going into Sept. 2024K123456Child's DOB (1st Player)* MM slash DD slash YYYY New to Lacrosse (1st Player)* Yes No USA LACROSSE MEMBER (1st Player)* Yes No USA LACROSSE NUMBER (1ST PLAYER) USA Lax Membership Expiration Date (1st Player)PLAYER MEMBERSHIP MUST NOT BE EXPIRED MM slash DD slash YYYY Registering 2nd Child?MULIT-PLAYER DISCOUNT -$20 OFF EACH ADDITIONAL PLAYER. Yes 2nd Child Name First Last 2nd Player's GradeGrade for September 2024K1234562nd Child's DOB MM slash DD slash YYYY New to Lacrosse (2nd Player) Yes No USA LACROSSE MEMBERSHIP (2nd Player) Yes No USA LACROSSE NUMBER (2ND PLAYER) USA Lax Membership Expiration Date (2nd Player)PLAYER MEMBERSHIP MUST NOT BE EXPIRED. MM slash DD slash YYYY Registering 3rd Child?MULIT-PLAYER DISCOUNT -$20 OFF EACH ADDITIONAL PLAYER - Yes 3rd Child Name First Last 3rd Player's GradeGrade entering September 2024K1234563rd Child's DOB MM slash DD slash YYYY New to Lacrosse (3rd Player) Yes No USA LACROSSE MEMBERSHIP (3rd Player) Yes No USA LACROSSE NUMBER (3RD PLAYER) USA Lax Membership Expiration Date (3rd Player)PLAYER MEMBERSHIP MUST NOT EXPIRE DURING THE SEASON OR YOU WILL NOT BE ABLE TO PARTICIPATE IN ANY MAD DOGS LACROSSE EVENTS. MM slash DD slash YYYY Is there any additional information we need to know? Medical Issues, etc.Parent/Guardian Name* First Last 2nd Parent/Guardian Name First Last Phone*2nd Contact PhoneEmail* 2nd Email Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code I have read and accepted the terms of the Waiver & Release I have read and accepted the terms of the Code of Conduct (PLEASE CLICK ON EACH DOCUMENT TO READ)Registration 1 PLAYER 2 PLAYERS 3 PLAYERS InsuranceInsurance must be purchased per player if they are not a USA Lacrosse Member. There are no discounts on insurance fee. Rosters are submitted to USA Lacrosse for Insurance Verification. NO EXCEPTIONS. Insurance - 1 PlayerInsurance - 2 PlayersInsurance - 3 PlayersPayment Options*If you are paying via check or cash - please email us for payment confirmation - PAYMENTS Online - PayPal or Credit/Debit Offline Payment - Please email for options Total Coupon EmailThis field is for validation purposes and should be left unchanged.
