2007 Registration / Information Form

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First Name		Last Name
Address
City		State		Zip
Home Phone		Player Email
Grade	Senior Junior Sophomore Freshman	Date of Birth (MM/DD/YYYY)

Did you play lacrosse last year? Returning Player New Player		If yes, What team did you play for? CBC Varsity CBC Junior Varsity CBC Developmental Other - Varsity Other - Junior Varsity Other - Developmental

US Lacrosse Membership Number

Years of lacrosse experience

Primary Postion Attack Midi Long Pole Midi Defense Goalie

Did you play goalie last year? Yes No

Jersey Number (Last Year)

(Requested)

Shirt Size Small Medium Large Extra Large 2X Large

Short Size Small Medium Large Extra Large 2X Large

Parent & Emergency Contact Information

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	Work Phone
Relationship		Cell Phone

Please choose a primary volunteer choice Parent Rep Fundraising Score/Time Keeper Web Admin Photographer Videographer

Please choose a secondary volunteer choice Parent Rep Fundraising Score/Time Keeper Web Admin Photographer Videographer

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 several dialogue boxes will appear. Please answer all questions properly to allow the form to be sent in. This will complete the online registration. Failure to do so will require the printed forms to be used or completed again manually at the initial club meeting.