GIRLS Registration 2012 | Mid Missouri Lacrosse League

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GIRLS League Annual Registration

Player Name(required)

Complete Addresse.g. 1134 E Maple St, Columbia, MO 65201(required)

Date Of Birth(required)

Age (as of January 1st this year)||(required)

Sex

Female

Grade(required)

School Attending(required)

High School District(required)

US Lacrosse Member Number and Expiration date

T-Shirt Size(required)

Parent 1 Contact InformationFirst Name, Last Name, Phone(required)

Parent 2 Contact InformationFirst Name Last Name, Phone

Preferred email address(valid email required)

Emergency contact if parent cannot be reachedName, Home Phone, Cell Phone, Work Phone(required)

Emergency Contact Relationship to Player(required)

Medical: AllergiesList allergies you want us to be aware of.(required)

Medical ConditionsList medical issues you want us to be aware of.(required)

Doctor Name and PhoneLast Name, First Name (573) 888-8888(required)

Dentist Name and PhoneLast Name, First Name (573) 888-8888(required)

Medical Insurance InfoCompany Name, Policy Number(required)

Medical Insurance Phone Number(required)

Medical Insurance Policy Holder Name(required)

Upload a copy of insurance card font and back

Upload your parent permission form

I am willing to participate as a parent on a MMLL committee

cforms contact form by delicious:days

For Girls League only: If you brought a friend who has never played with MMLL before, and she registers for this season, you get $20.00 off of your registration. Just select the lower registration fee and include the name of the girl you brought. NOTE: If your friend does not register, you will be required to pay the standard registration fee.

Registration options

Name of friend