Registration

Little Sticks Registration

Player Name(Required)

First Last

Player Grade(Required)

Select Your School/Location(Required)

*The player must attend the school selected here.

Teacher Name(Required)

ASEP(Required)

Yes, my child is in ASEP and will need to be taken there post session

No, my child is not in ASEP and will be picked up at the conclusion of the session

Birth Date(Required)

Player Gender(Required)

Parent/Guardian Name(Required)

First Last

Parent/Guardian Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Email(Required)

Parent/Guardian Cell Phone(Required)

Emergency Contact(Required)

First Last

Emergency Contact Cell Phone(Required)

Emergency Contact Email(Required)

Special Instructions

Health Related Instructions

Health Insurance Information(Required)

You you want to purchase a lacrosse stick?(Required)

No, we have a stick

Yes, we need to purchase a stick

Coupon

Total

Credit Card

Card Details

Cardholder Name