Program Registration
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Player Name
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First Name
Last Name
Date of Birth
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MM
DD
YYYY
Parent/Guardian Name
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First Name
Last Name
Parent/Guardian Email
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Parent/Guardian Phone Number
Secondary Parent/Guardian Name
First Name
Last Name
Secondary Parent/Guardian Email
Secondary Parent/Guardian Phone Number
(###)
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Player Email
Player Phone Number
(###)
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Player Rising Grade
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School Attending This Fall
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Player's Previous Lacrosse Experience
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Any Known Dates the Player is Unavailable
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Known Allergies or Medical Conditions
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USA Lacrosse Membership Expiration Date
MM
DD
YYYY
Uniform and T-Shirt Size
*
If T-Shirt Size is Different, Note T-Shirt Size
Medical Treatment Authorization
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In the event of illness or injury, I authorize Marble City Lacrosse, LLC coaches, volunteers, and staff to secure necessary medical treatment for my child. I understand every effort will be made to contact a parent or guardian before such action is taken. I assume responsibility for all medical costs incurred.
Release of Liability and Medical Release
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In consideration of my, or my child or ward's, participation in any Marble City Lacrosse, LLC activity, I acknowledge and accept the risks, including the risk of catastrophic injury, paralysis, or even death, associated with participation in lacrosse-related activities. I further agree, on behalf of myself, my heirs, and personal representatives, to release Marble City Lacrosse, LLC and its affiliates, coaches, volunteers, and staff from any liability for injury, loss of life, or any damages resulting from participation in any Marble City Lacrosse, LLC event.
Media Release
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I grant Marble City Lacrosse, LLC permission to use my child's likeness (photos, videos, name, voice, performance, etc.) for promotional purposes without charge or restriction. I release Marble City Lacrosse, LLC from any claims related to this usage.
Certification
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Parent/Guardian Name (Digital Signature)
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First Name
Last Name
Thank you! We will be in contact with the team soon with details about the summer.
Use the link below to complete payment and finalize registration.
We’re glad you have joined the Marble City Lacrosse family! Please reach out to us if you need anything.
