2012 Player Registration

All players will need to complete this form by June 30, 2012.

Name of Minor/Participant:
First Name Last Name

Date of Birth

Graduation Year

Parent's Email

Player's Email (optional)

Home Phone - -

Street

City State/Province Zip/Postal Code

Team Information:

Youth Brackets (AA, A & B Divisions):
- U-11 - Sep 1, 2000 birth date or younger
- U-13 - Sep 1, 1998 or younger
- U-15 - Sep 1, 1996 or younger* (*Eligible U15 Players should have not played any Freshmen or JV or Varsity High School Lacrosse)
High School Brackets (A & B Divisions):
- JV/Rising Stars - Rising Freshmen (2016 grad year) & Rising Sophomores (2015 grad year) only
- Varsity/Elite - Rising Seniors (2013 grad year) or younger

Note: Any player can play "up" in an older division. No player may play "down" in a younger division.

Bracket / Team / Coach

Position

JV/Rising Stars and Varsity/Elite players only

Jersey Number

High School

Emergency Information

Emergency Contact Name

Relationship to Participant

Emergency Contact's Phone - -

Health Insurer Policy Number

Participant's US Lacrosse Number

US Lacrosse Expiration Date

» Release and Waiver of Liability, Assumption of Risk, Indemnity and Parental Consent Agreement

I have READ and ACCEPT the Release and Waiver of Liability, Assumption of Risk, Indemnity and Parental Consent Agreement. This shall serve as my digital signature and is my binding mark.

Name of Person Completing Event Consent/Waiver Form

Relationship to Participant

I have read and agree to abide by the Patriot Games Code of Conduct