2009 Registration / Information Form
For the CBC Lacrosse Club

First Name   Last Name     
   
Address   
City    State       Zip   
       
Home Phone    Player Email (CBC Address)    
       
 
Player Cell         Cell Phone Carrier (for Text Msgs)     
Cell phone number and Carrier will be used to send text messages regarding changes in game or practice times

Grade   Date of Birth (MM/DD/YYYY)    

 

US Lacrosse Membership Number (if known)  
If player is not registered, the club will provide membership as part of the players fees.
If the player is registered for the 2008 season, the fee will be reduced
 
Parent & Emergency Contact Information
xxxxxxxxxx
(no dashes)
Father's Name    Work Phone   
Email    Cell Phone   
Mother's Name    Work Phone   
Email    Cell Phone   
Emergency Contact*     
* Please use an emergency contact other than a parent 		Primary Contact
Phone Number
Relationship    Secondary Contact
Phone Number

Please choose a primary volunteer choice
           Please choose a secondary volunteer choice

Special Comments

Note: As a precaution please print your application and bring to the meeting. This will be used if there is any issue transmitting your application.

Also, after hitting submit you should receive a confirmation at the top of the screen.
Please answer all questions properly before hitting submit to allow the form to be transmitted properly.
Failure to do so may require you to complete the forms again manually at the initial club meeting.