Women's Lacrosse Play Day Registration

Please complete this form. Once you have submitted the form, you will be taken to a page with a link to make your credit card payment.

Participant First Name*

Participant Last Name*

High School

Grade

Age

Varsity Experience

T-Shirt Size*

Parent(s) Name(s)*

Home Phone

Cell

Address

City

State

Zip

Health Information and History

Emergency Contact*

Phone*

Allergies (Food, Drug or Other) If none, please type "none"*

Chronic or recurring Illness (Asthma, Diabetes, or Other) If none, please type "none".*

Operation or Serious Illnesses

Are you taking any medications?*

Please explain any specific problems which would affect the athlete's participation in this activity.

Insurance Information

Name of Insurance*

Member ID*

Group #*

I agree to allow treatment of any injuries sustained at HCC WLAX Play Day for my child.*