2019 Galena Lacrosse Player & Parent Registration Forms & Contracts
Welcome to the Galena Lacrosse Program!
Before you begin, you may want to visit http://www.uslacrosse.org/membership.aspx as you will need your US Lacrosse Membership number and Expiration date.
PLAYER INFORMATION
Galena Lacrosse Club Team Eligibility *
Please note: In accordance with High Sierra Lacrosse League Policy, Galena Lacrosse Club is open to Galena High School Students, or students who live within the Galena High School attendance boundaries attending a school without a lacrosse team.
Required
Galena Lacrosse Club Team *
Required
Player Legal First Name *
Your answer
Player Legal Last Name *
Your answer
Player Nickname
Your answer
Player Home Street Address *
Your answer
Player Home Address Zip *
Your answer
Player Cell Phone *
Your answer
Player Email (Used for Krossover registration and film messaging) *
Your answer
Player Birthday *
MM
/
DD
/
YYYY
Player Year in School *
Required
Please indicate if you have a desired position, otherwise you may leave blank.
Your answer
Please indicate if you have played for another Club Team and which one (Aces, Booth, Avalanche, etc.).
Your answer
Interested in continuing play in college? *
Required
What is your Lacrosse Experience? *
Required
US Lacrosse Member ID *
What is this? You must have a US Lacrosse ID to play on our team. You register directly with US Lacrosse here http://www.uslacrosse.org/membership.aspx. If you already registered, you can look up your membership number and expiration date here also.
Your answer
US Lacrosse ID Expiration *
Same link above will allow you to look up your number and see your expiration date.
MM
/
DD
/
YYYY
Uniform Shirt Size
*Girls Lacrosse Only
PARENT INFORMATION
Mother/Guardian First Name *
Your answer
Mother/Guardian Last Name *
Your answer
Mother/Guardian email *
Your answer
Mother/Guardian Phone *
Your answer
Father/Guardian First Name *
Your answer
Father/Guardian Last Name *
Your answer
Father/Guardian email *
Your answer
Father/Guardian Phone *
Your answer
Emergency Contact Name/s *
Your answer
Emergency Phone (3-7 p.m. weekdays) *
Your answer
Home Phone ( if applicable)
Your answer
Has your child ever suffered a concussion? *
Required
If YES, your child suffered a concussion, please describe the date and cause?
Your answer
Does your child have any health issues, allergies or other issues we need to know about? *
Your answer
This form must be completed by students AND Parents/Guardians. Please continue.
Authority to Register and/or to Act as Agent. You represent and warrant to Galena Lacrosse Club that you have full legal authority to complete this registration, including full authority to make payments to the club. In addition, if you are registering third parties, you represent and warrant that you have been duly authorized to act as Agent on behalf of such parties in performing this registration. By proceeding with this registration, you agree that the terms of this Registration Agreement shall apply equally to you and to any third parties for whom you are acting as Agent. By proceeding with this registration, you agree that you are in compliance with the Children's Online Privacy Protection Act (COPPA). You represent and warrant that, in compliance with COPPA, you are over thirteen (13) years of age, and that if you are registering a child under fourteen (14) years of age you are the parent or guardian of such child, and do hereby consent to the collection of such child's personal information by Galena Lacrosse Club and other affiliated organizations. *
Required
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