RocE6 2019 Lacrosse Registration Form
Please complete the form below to register your son or daughter for the 2019 RocE6 Lacrosse Season at Thomas P. Ryan Center (School #33) or SWAN Community Center (Wilson Foundation Academy)
Email address *
Student-Athlete Name *
Your answer
School Name *
Your answer
Teacher's Name
Your answer
Grade *
Your answer
Date of Birth
MM
/
DD
/
YYYY
RocE6 Team (East - School #33/West - Wilson Foundation Academy/SWAN)
Gender
Parent Name
Your answer
Parent Cell Phone
Your answer
Address
Your answer
Zip Code
Your answer
Any Allergies/IEPs/Health Condition Concerns
Your answer
Emergency Contact Name/Relationship
Your answer
Emergency Contact Number
Your answer
Photo Consent - I hereby consent that all photographs taken by ROC E6, Inc and its affiliates may be used by ROC E6, Inc for publication on the company’s web-site, newspaper articles or any purpose ROC E6, Inc deems proper.
Field Trip/ Away Game Consent - I hereby consent for my child, to take field trips/Away games as a part of the ROC E6, Inc. 2018 Lacrosse Program. Transportation for field trips may be provided by an independent transportation system/Coach/Parent. My signature below is my consent to have my child participate and be transported under the above conditions.
Parent/Guardian Signature
Your answer
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