Jacksonville Juice Lacrosse Registration Form: 2019 High School Recreational Team
PLEASE COMPLETE THIS FORM IN ITS ENTIRETY. All players are required to register with USLacrosse.org prior to participating in team activities, including team practices. Registrants under 18 years of age require guardian consent. Registration implies consent to use player photograph and likeness in print and digital publications, commercial advertising, promotional material and social media.

A one time registration fee of $135.00 is required to complete registration. (*price may change due to additional equipment options*)

Email address *
Are you currently playing for a County High School Team in addition to the Juice Team? (if you are you will required to have your Head coaches written consent submitted to Coach Josh prior to the first day of practice) *
If you answered yes to the above question please provide your High School Coaches information to include what school you are attending:
Your answer
Player Name: *
Your answer
U.S. Lacrosse Member Number (must be valid through July 2019): *
Your answer
What is your current grade (2018/2019 school year)? *
Address: *
Your answer
Players Phone Number: *
Your answer
Parents Phone: *
Your answer
Date of Birth: *
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DD
/
YYYY
Emergency Contact (Name and Phone): *
Your answer
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