Registration Form

JAB LACROSSE Fall Registration Form

* Indicates required field

Date of Birth *

Name *

First

Last

Address *

Email *

City, State *

Zip Code *

Phone Number *

Current School *

Current Grade *

US Lacrosse Membership Number *

Parent Name *

Parent E-Mail *

Participant Health Insurance Company *

Policy Number *

Emergency Medical Treatment Authorization I (we) the undersigned, hereby certify that I (we) are the parent or guardian of the participant and hereby give permission to JAB Lacrosse and the training staff to seek appropriate medical attention as necessary to insure the wellbeing of my (our) daughter. *

Accept Decline

I (we) the undersigned, for ourselves, our heirs, executors, and administrators, waive, release and forever discharge the Training staff, officers, agents, employees, representatives, successors, and assign of and from all rights and claims for damages, injuries, or loss of person or property, which may be sustained or occur during participation in practices and tournaments, whether or not damages, injury, or loss is due to negligence. *

Accept Decline

Parent name confirming online waiver release *

Date of Online Waiver Acceptance *

Submit