Interested in joining Liberty Lacrosse?   
Fill out our application today.   
About
Coaches
Calendar
Directions
Application
Alumni
Mailing List
Links
Contact
 
LaxHut
 
Please complete the online application below. Note: if required fields are not submitted, or submitted incorrectly, your application will be returned to you.
First Name: *
Last Name: *
Date of Birth: *
Phone Number: * [ i.e. 516-555-1234]
Player's Email Address: *
Parent's Email Address:
Street Address 1:
Street Address 2:
City:
State:
Zip Code: [5 digits - for example 12345]
High School: *
Graduation Year: * [4 digits - for example 2007]
Position Prefered:
 
US LACROSSE MEMBERSHIP INFORMATION
No player will be admitted on the field without a current U.S. Lacrosse membership.
US Lacrosse Number: *
US Lacrosse Exp. Date *
 
MOTHER
First Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
   
FATHER
First Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
   
EMERGENCY CONTACT INFORMATION
Contact Name: *
Contact Number: *  [ i.e. 516-555-1234]
Health Insurer: *
Policy Number: *
Medical Alert Information
(list any medical problems here)
   
UNIFORM
Jersey Size: [Adult Women's Sizes] *
Short Size:
 

© Liberty Lax 2003 Site Design: DJDesign