Player Registration

Player Info:

First Name (required)

Last Name (required)

Birthday (mm/dd/yyyy) (required)

School (required)

Grade (required)

Age (required)

US Lacrosse Membership #(required)

Please Note: All players must carry a US Lacrosse Membership. This serves as the player's insurance. To renew or signup go to www.USLacrosse.org

Parent/Guardian Information:

Primary Contact Name (required)

Primary Contact Relation (required)

Primary/Emergency Number (required)

Secondary Contact Name (required)

Secondary Contact Relation (required)

Secondary Phone Number (required)

Email Address (required)

Street Address (required)

City (required)

State (required)

Zip Code(required)

• Refunds must be requested in writing BEFORE the first regular season game.
• NO refunds will be issued after the first season game.

*By checking this box I agree to hold harmless Seckman Lacrosse Club for any accidents or injuries sustained by the minor as a result of his or her participation in this program and accept full responsibility for any and all medical and/or other expenses incurred thereby either private insurance coverage or personal liability.*