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Lacrosse Clinic Series *
Check all that apply
Player Name *
Player Name
Gender
Date of Birth *
Date of Birth
Address *
Address
Cell Phone *
Cell Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
$20 per player per clinic
$
Payment *
Expiration Date
Expiration Date
Name on Credit Card
Name on Credit Card
As it appears on credit card
AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY
Signature *
Checking this box certifies that I, as parent or guardian with legal responsibility for the Participant, do consent and agree to the releases provided above.
Today's Date
Today's Date