FALCONS LACROSSE REGISTRATION FORM. Last Name: First Name: Address: ... Grade in September 2014/2015: ______ School Name
2015 FALCONS LACROSSE REGISTRATION FORM Last Name: ___________________________ First Name: _______________________ Address: _______________________________________________________________ Birthday: ___/___/___ Age: __________ Proof Of Residency: ____________________ Grade in September 2014/2015: __________ School Name: _________________________ Parents/Guardians Name: _______________________________________________ Phone (Home): ________________________________________ Phone (Cell): __________________________________________ Relationship: ______________________E-mail address: __________________________ I, undersigned Parent/Guardian give my child permission to play in the Saddle Brook Recreation Lacrosse Program. The Saddle Brook Recreation Department will assume responsibility only during practices scheduled by coaches and regular scheduled games as a Secondary insurance carrier after first submitting any claims to your primary health insurance carrier.
_____________________________________ Parent of Guardian Signature
Registration Fee:
____________________ Date
$50 Resident $65 Non Resident Payment must be made in full by January 23rd, 2014. Checks are to be made out to:
SADDLE BROOK JR. LACROSSE ***In addition to fee: All players MUST have a US Lacrosse number. This can be done through USLacrosse.org US Lacrosse number:__________________________ US Lacrosse Expiration Date:________________________
For Additional information on the league, Please visit our website at: http://www.sbfalcons.teampages.com/ You can also call or email any questions or concerns to: Vince Cirello: 201-615-5364
[email protected] 