Important note: Please enter in the “Program Participating” field the program you would like to register for. ex. Summer Camp, Indoor Winter League, Fall Teams, etc.
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
Date
