MI Rush Lansing Jr. Academy Spring 2017 Sessions Registration Form
Please complete the form below to register your player for the MI Rush Lansing Jr. Academy Spring 2017 Sessions.

Sessions take place at either Holt, St. Thomas or St. Johns. Sign up for one of the locations. All games will be held at the St. Thomas location on Saturdays.

Holt North Campus- 5780 Holt Rd, Holt, MI 48842
St. Thomas- 955 Alton Rd, East Lansing, MI 48823
St. Johns- 600 Townsend Rd, St. John, MI 48879

Holt North Campus Spring 2017 Sessions
Tuesday, April 18: 6pm - 7pm
Tuesday, April 25: 6pm - 7pm
Tuesday, May 2: 6pm - 7pm
Tuesday, May 9: 6pm - 7pm
Tuesday, May 16: 6pm - 7pm
Tuesday, May 23: 6pm - 7pm

St Thomas Spring 2017 Sessions
Wednesday, April 19: 6pm - 7pm
Wednesday, April 26: 6pm - 7pm
Wednesday, May 3: 6pm - 7pm
Wednesday, May 10: 6pm - 7pm
Wednesday, May 17: 6pm - 7pm
Wednesday, May 24: 6pm - 7pm

St. Johns Spring 2017 Sessions
Thursday, April 20: 6pm - 7pm
Thursday, April 27: 6pm - 7pm
Thursday, May 4: 6pm - 7pm
Thursday, May 11: 6pm - 7pm
Thursday, May 18: 6pm - 7pm
Thursday, May 25: 6pm - 7pm

St Thomas Spring 2017 Games
Saturday, April 22: 9am, 10am, 11am
Saturday, April 29: 9am, 10am, 11am
Saturday, May 6: 9am, 10am, 11am
Saturday, May 13: 9am, 10am, 11am
Saturday, May 20: 9am, 10am, 11am
Saturday, May 27: 9am, 10am, 11am

Cost: $80, includes t-shirt.

Once you have registered for the program, you will receive a confirmation email with further details and the program waivers.

Payment and waivers will be collected on the first day of each session. We accept cash or checks - make checks payable to "First Touch."

For more information, contact the Director of the Jr. Academy, Tommy Ziolkowski.
Phone: 517-410-3898. E-mail: tommyziolkowski@yahoo.com

Player First Name
Your answer
Player Last Name
Your answer
Player Age
Player Birth Year
Player Birth Date
MM
/
DD
/
YYYY
Player Gender
Your answer
Player T-shirt Size
We do our best to accommodate, but we cannot guarantee requested size.
I am registering my player for:
Holt, St Thomas or St Johns location
Required
Name of Parent/Caregiver #1
Your answer
Email of Parent/Caregiver #1
Your answer
Phone Number of Parent/Caregiver #1
Your answer
Emergency Contact Name
Not a parent.
Your answer
Emergency Contact Phone Number
Not a parent.
Your answer
Emergency Contact Relation to Player
Not a parent.
Your answer
Name of Parent/Caregiver #2
Your answer
Email of Parent/Caregiver #2
Your answer
Phone Number of Parent/Caregiver #2
Your answer
School District
Your answer
Zip Code
Your answer
Have you previously participated in the Jr. Academy?
How did you learn about the Jr. Academy?
Your answer
Is there anything we should know about your player?
For example, a medical condition or food allergies.
Your answer
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