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Patriot Lacrosse

Thursday, September 09, 2010
 
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Registration Information
 
Age Level: Girls: Returning Spring Player - No Uniform Needed Player Cost: $130.00

Player Information
First Name: Last Name:
Grade: Gender:
Birth Date: School:
Last Season Played: Previous Season's Team:
Tryout Intention:
US LAX Member Number: Expiration Date:

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Parent's Information
Parent Names: Home Phone:
Address: City:
State: Zip:
Mom's Information: Dad's Information:
Email Address: Email Address:
Work Phone: Work Phone:
Cell Phone: Cell Phone:
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(This option will not allow you to make payments over the web in the future.)
I grant Patriot Lacrosse Club and their respective successors and assign the perpetual worldwide and royalty-free rights to use, for the purposes of marketing and with the possibility of sale for the profit of the Patriot Lacrosse Club, my child's voice, photograph, and likeness, in any media related to my child's participation in Patriot events or any activities relating to Patriot events conducted by the Patriot Lacrosse Club including, without limitation, photographs and/or a videotape recording, without compensation to me, or my personal representatives, assigns, heirs, children, dependents, spouse and relatives.