2022 Galena Lacrosse Player & Parent Registration Forms & Contracts
Welcome to the Galena Lacrosse Program!  
Before you begin, you may want to visit http://www.uslacrosse.org/membership.aspx as you will need your US Lacrosse Membership number and Expiration date.
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PLAYER INFORMATION
Galena Lacrosse Club Team Eligibility *
Please note: In accordance with High Sierra Lacrosse League Policy,  Galena Lacrosse Club Team is open to Galena High School Students, or students who live within the Galena High School attendance boundaries attending a school without a lacrosse team.
Required
Galena Lacrosse Team *
Required
Player Legal First Name *
Player Legal Last Name *
Player Nickname
Player Home Street Address *
Player Home Address Zip *
Player Cell Phone (Used for team/player correspondence) *
PLAYER Email (Used for HUDL registration and film messaging) *
Player Birthday *
MM
/
DD
/
YYYY
Player Year in School *
Required
Please indicate if you have a desired position, otherwise you may leave blank.
Please indicate if you have played for another Club Team and which one (Aces, Booth, Avalanche, etc.).
Interested in continuing play in college? *
Required
What is your Lacrosse Experience? *
Required
US Lacrosse Member ID *
What is this? You must have a US Lacrosse ID to play on our team. You register directly with US Lacrosse here http://www.uslacrosse.org/membership.aspx. If you already registered, you can look up your membership number and expiration date here also.
US Lacrosse ID Expiration *
Same link above will allow you to look up your number and see your expiration date.
MM
/
DD
/
YYYY
Uniform Shirt Size
*Girls Lacrosse Only
PARENT INFORMATION
Mother/Guardian First Name *
Mother/Guardian Last Name *
Mother/Guardian email *
Mother/Guardian Phone *
Father/Guardian First Name *
Father/Guardian Last Name *
Father/Guardian email *
Father/Guardian Phone *
Emergency Contact Name/s *
Emergency Phone (3-7 p.m. weekdays) *
Home Phone ( if applicable)
Has your child ever suffered a concussion? *
Required
If YES, your child suffered a concussion, please describe the date and cause?
Has your child had a baseline concussion test before?
If YES, your child had a baseline concussion test, do you have access to that baseline information?
Does your child have any health issues, allergies or other issues we need to know about? *
This form must be completed by students AND Parents/Guardians. Please continue.
Authority to Register and/or to Act as Agent. You represent and warrant to   Galena Lacrosse Club that you have full legal authority to complete this registration,   including full authority to make payments to the club. In addition, if you are registering   third parties, you represent and warrant that you have been duly authorized to act as   Agent on behalf of such parties in performing this registration. By proceeding with this   registration, you agree that the terms of this Registration Agreement shall apply equally   to you and to any third parties for whom you are acting as Agent. By proceeding with   this registration, you agree that you are in compliance with the Children's Online Privacy   Protection Act (COPPA). You represent and warrant that, in compliance with COPPA,   you are over thirteen (13) years of age, and that if you are registering a child under   fourteen (14) years of age you are the parent or guardian of such child, and do hereby   consent to the collection of such child's personal information by Galena Lacrosse Club   and other affiliated organizations. *
Required
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