Puget Sound Select - Fall/Winter 2019
Thank you for your interest and participation in PSS! We are really excited to have you in our program for the summer season. Please fill out the registration form!
Email address *
Players Name (First and Last) *
Your answer
Uniform number (for returning players)
Your answer
Players Date of Birth *
MM
/
DD
/
YYYY
High School Graduation Year *
Your answer
Current School Program or Club (ex. Holy Names, Queen Anne Quick Styx, Nathan Hale) *
Your answer
Player Email *
Your answer
Player phone (if applicable) *
Your answer
Parent/Guardian Email(s) *
Your answer
Parent/Guardian phone(s) *
Your answer
US Lacrosse Membership # *
Your answer
Medical Insurance (name and policy #) *
Your answer
Emergency Contact (name and phone) *
Your answer
List any known medical conditions or injuries *
Your answer
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