After Dark Lacrosse Goalie Registration

Instructions ALL Players MUST check in each night and have an official Harford Sports Lacrosse Jersey. Jersey $20 each player. .

Goalie Name: *

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Your preferred position:

Goalies are free, but must purchase a Men's Lacrosse Jersey unless you already have a Men's Lacrosse Jersey from the previous year.Goalie

Select

Primary Contact Name: *

Primary Contact Cell # *

Primary Contact Email: *

AGE: *

Secondary Contact Name: In Case of Emergency

Secondary Contact Cell #

Secondary Contact Email:

I certify As the undersigned Parent/Legal Guardian of the Player named above I understand that my child will not be covered by any program insurance, and agree that I will not hold the team, the club, the coach, any instructors or Harford Sports Performance Center responsible for injuries received while participating in the above tryout and/or program.
Digital Signature *
YesNo
Date Signed: *