Kent Youth Lacrosse 2009
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2009 Registration Form
 
Please begin by reading the medical release form.  Towards the end of this on-line registration, you will be asked if you have read and agree to the parameters.  Remember -- you must fill out a separate registration form for each player.  After submitting this form, please use the PAYMENT link to complete your registration.  Don't forget you must also register with  USLacrosse.
 

Player's full name:

Player's Gender:
Male
Female
Player's Date of  Birth (mm/dd/yy):

Age (as of Jan. 1, 2009):

Player's Height (ft' in'') / Weight (in lbs.)
Parent(s) / Guardian Name:

Mailing Address:

 

Home Phone Number:
Emergency Contact Number:
Release and Waiver by Participants:
(click HERE to read the medical release form)
Parent's Email Address:
Please describe any health factors (including asthma, allergies, medications, recent surgeries or illnesses, broken bones or sprains) that make it advisable for this child to follow a limited program of physical activity:

Insurance Company:

Policy Number: