Harrisburg Lacrosse Summer League



Return for WITH FEE AND SIGNED WAIVER to your team captain,

or if individual registration send form and $90.00 fee to:


Harrisburg Lacrosse

PO Box 13089

Harrisburg, PA 17110


MAKE CHECKS PAYABLE TO:                Harrisburg Lacrosse



Name: ________________________________________         

Date of Birth: __________________

 Parent / Guardian Name (for high school or younger): ________________________________________________

 Street Address: ______________________________________________________________________


City/State/Zip: ______________________________________________________________________Phone: _______________

E-Mail Address: ________________________________________________

 Emergency Contact:_________________________________ Phone:__________________________________

 Playing Experience (years): __________   Name of High School\College: __________________________________                

Your year in school (Elem. / Middle / HS / College): ________________________

Position(s) played: _______________________________

Preferred position: _______________________________  

 Years of Experience in H.S. ________; College ________; Summer League ________; Club Team(s) ________


 I would like to play with the following players or on the following team: Team:____________________________________