MOTOR CITY KNIGHTS LACROSSE
MOTOR CITY KNIGHTS LACROSSE 2015 SPRING REGISTRATION FORM PLAYER INFORMATION: (please print clearly) th (freshman)
Name:
Circle Team (grade) 3/4
Grade:
Age:
Date of Birth:
Positions you want to play (circle all that apply) Defense
5/6
th (JV)
th (varsity)
7/8
Yrs of Experience Attack
Jersey Size – YS YM YL AS AM Short Size – YS YM YL AS AM All Jerseys and shorts to be returned at the end of the season.
AL AL
Midfield AXL AXL
Goalie
H.S.
(high school)
Graduation Year
LSM
SCHOOL:
AXXL AXXL
REGISTRATION COSTS (please check one) (LATE REGISTRATION PERIOD 1/1/15 – 2/1/15) th
3/4 grade ($230.00) __ 5/6 grade ($330.00)__ 7/8 grade ($330.00)__ H.S. ($330.00)__
PARENT/GUARDIAN INFORMATION: (please print clearly) Parent/Guardian(s) Name(s): Relationship to Participant (circle): Mother Father Guardian Grandparent Aunt/Uncle Address: PH# 1
PH#2
TEXT FRIENDLY#
Email Address: How did you hear about us (internet, school, parks & rec., friend, etc.) Emergency Contact Information: (please print clearly) Emergency Contact Name:
Emergency Contact Phone:
Please note and medical concerns and/or allergies concerning the participant: Medical Insurance Policy Holder:
Insurance Policy #:
Insurance Provider: Please circle any volunteer positions you may be interested in: Team Mom
Concessions
Time Clock Cleanup
Stats
Setup
Video
Coach/Assistant
Special Events
Make Check Payable to: Vision Lacrosse Academy LLC P.O. Box 272 Fraser, MI 48026 Please send all the required forms (forms tab) along with payment by 12/31/14 (2/1/15) 1. VLA & MCK Code of Conduct Agreement 2. MCK Registration Refund Agreement 3. NB Parks & Rec Waiver 4. VLA & MCK Enrollment Agreement & Waiver 5. Concussion Awareness Form 6. Registration Form 7. Check Motor City Knights is owned and operated by Vision Lacrosse Academy LLC – Website: WWW.MOTORCITYKNIGHTS.COM
VLA Use Only - Circle and Fill in Check#____________ Cash ______________ REG,
VLA
NB
FR JV
VARSITY
Code of Conduct CONC.
REF.
HS
Name:
Circle Team (grade) 3/4
Grade:
Age:
Date of Birth:
Positions you want to play (circle all that apply) Defense
5/6
th (JV)
th (varsity)
7/8
Yrs of Experience Attack
Jersey Size – YS YM YL AS AM Short Size – YS YM YL AS AM All Jerseys and shorts to be returned at the end of the season.
AL AL
Midfield AXL AXL
Goalie
H.S.
(high school)
Graduation Year
LSM
SCHOOL:
AXXL AXXL
REGISTRATION COSTS (please check one) (LATE REGISTRATION PERIOD 1/1/15 – 2/1/15) th
3/4 grade ($230.00) __ 5/6 grade ($330.00)__ 7/8 grade ($330.00)__ H.S. ($330.00)__
PARENT/GUARDIAN INFORMATION: (please print clearly) Parent/Guardian(s) Name(s): Relationship to Participant (circle): Mother Father Guardian Grandparent Aunt/Uncle Address: PH# 1
PH#2
TEXT FRIENDLY#
Email Address: How did you hear about us (internet, school, parks & rec., friend, etc.) Emergency Contact Information: (please print clearly) Emergency Contact Name:
Emergency Contact Phone:
Please note and medical concerns and/or allergies concerning the participant: Medical Insurance Policy Holder:
Insurance Policy #:
Insurance Provider: Please circle any volunteer positions you may be interested in: Team Mom
Concessions
Time Clock Cleanup
Stats
Setup
Video
Coach/Assistant
Special Events
Make Check Payable to: Vision Lacrosse Academy LLC P.O. Box 272 Fraser, MI 48026 Please send all the required forms (forms tab) along with payment by 12/31/14 (2/1/15) 1. VLA & MCK Code of Conduct Agreement 2. MCK Registration Refund Agreement 3. NB Parks & Rec Waiver 4. VLA & MCK Enrollment Agreement & Waiver 5. Concussion Awareness Form 6. Registration Form 7. Check Motor City Knights is owned and operated by Vision Lacrosse Academy LLC – Website: WWW.MOTORCITYKNIGHTS.COM
VLA Use Only - Circle and Fill in Check#____________ Cash ______________ REG,
VLA
NB
FR JV
VARSITY
Code of Conduct CONC.
REF.
HS
