College Connections Lacrosse Clinic Sign-up
PLAYER INFORMATION
Player First Name *
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Player Last Name *
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Date of Birth *
MM
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DD
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YYYY
Grade Entering *
Years of Experience *
Position *
Strong Hand
PARENT/ GUARDIAN INFORMATION
Parent's First Name *
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Parent's Last Name *
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Address *
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City *
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State *
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Preferred Email Address *
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Cell Phone *
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EMERGENCY CONTACT INFORMATION
Emergency Contact First Name *
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Emergency Contact Last Name *
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Emergency Contact Number *
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MEDICAL INFORMATION
Physicians Name *
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Physicians Number *
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Insurance Carrier *
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Insurance ID Number *
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Medical Concerns (Please respond "None" if there are no concerns) *
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Session Sign-Up
Session(s) *
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