860 Lacrosse Registration
we'll email your invoice separately
Sign in to Google to save your progress. Learn more
Registering For... *
Email *
Last Name *
Parent or Guardian
First Name *
Parent or Guardian
Mobile # *
use a number that doubles for regular communication & EMERGENCY CONTACT
Address
For ID purposes only
Town *
Player Name *
Player DOB *
MM
/
DD
/
YYYY
Grad Year
US Lacrosse Membership #
https://www.usalacrosse.com/membership
Expiration Date
US Lacrosse Membership
MM
/
DD
/
YYYY
Experience Level
Clear selection
Lacrosse Gear
Clear selection
Health Insurance *
does the player have health insurance?
PCP
name and phone number of player's primary care physician
I have clicked the link above, read the RELEASE OF LIABILITY, and accept its terms and conditions
Signature *
Please type your full legal name. This is your E-Signature.
How did you hear about us?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy