Registration Form

Fill out the form below.
All athletes must fill out BOTH a Registration Form and Insurance Waiver Form.
If you would like to print the Registration Form and hand it in, you can download it here. 

Athletes Name

Parent/Guardian Name

Address

Email

Home Phone

Cell Phone

Athletes Date of Birth

Athletes Age

School

Program Participating

I certify that I have completed a STATEN ISLAND LACROSSE waiver and release liability form, and that my child has been given a complete physical by a physician and has no ailments or disabilities that may keep them from participating in athletic play. Permission is hereby granted to STATEN ISLAND LACROSSE for my child to receive emergency medical treatment if needed.
 I AGREE I DO NOT AGREE

Parent/Guardian Name

Date