2018/19 Falcons Lacrosse Registration
Form must be completed in it's entirety .
Player First Name *
Your answer
Player Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in School *
Home Address *
House number, Street, City and Zip Code
Your answer
School Attending *
Your answer
Player Cell Phone
Your answer
Player Email
Your answer
Guardian #1 Name *
Your answer
Relationship to player *
Your answer
Guardian #1 Cell phone
Your answer
Guardian #1 Email
Your answer
Guardian #2 Name
Your answer
Relationship to player
Your answer
Guardian #2 Cell Phone
Your answer
Guardian #2 Email
Your answer
Do you agree to have player and parent contact phone and email shared on a team directory. *
Clarification of "Other" on previous question.
Your answer
Doctor's Name *
Your answer
Doctor's Phone # *
Your answer
Preferred Hospital *
Your answer
Medical Insurance Company *
Your answer
Insurance ID # *
Your answer
Primary Subscriber Name/Medical Ins. *
Your answer
Allergies *
Your answer
Does Player carry an Inhaler or EPI Pen
Your answer
Does Player have a history of concussions? *
Explain history of concussions
How many, how long ago, loss of consciousness?
Your answer
Medical conditions that may affect your child’s participation in lacrosse: *
Your answer
US Lacrosse Number *
Go to https://www.uslacrosse.org/ if you need to register or look up your number.
Your answer
Expiration Date of US Lax # *
Your answer
For PLAYER: Please click on link and read "Falcons Attendance Policy". Then check the box below confirming that you have read and agree to the terms. *
Required
For PARENT: Please click on link and read "Falcons Attendance Policy". Then check the box below confirming that you have read and agree to the terms. *
Required
For PLAYER: Please click on link and read "Falcons Code of Conduct". Then check the box below confirming that you have read and agree to the terms. *
Required
For PARENT: Please click on link and read "Falcons Code of Conduct". Then check the box below confirming that you have read and agree to the terms. *
Required
For PARENT: Please click on the link and read "Falcons Release of Liability Waiver". Then check the box below confirming that you have read and agree to the terms. *
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