Queen City Stars Lacrosse

Registration

Event Details

Queen City Stars

Membership Registration

Select your Membership:

Player Info

First Name:*
Last Name:*
Address 1:*
Address 2:
City:*
State:*
Zip Code:*
Mobile Phone:
Email Address:

Player Details

Date of Birth:*
Graduation Year:*
School Name:*
Desired Positions:*	GK A M D
Years Played:*
US Lacrosse #:
Reversible Size:*
T-Shirt Size:*
Sweatshirt Size:*
Returners please fill in your current jersey number only. New players please list your top 4 choices for a jersey number from #1-100
Jersey #'s:*

Medical Conditions

Special Instructions / Requests for Player

Parent / Guardian 1 (Primary)

First Name:*
Last Name:*
Email Address:*
Home Phone:*
Mobile Phone:*

Parent / Guardian 2

First Name:
Last Name:
Email Address:
Home Phone:
Mobile Phone:

* I / We, understand the following refund policy applies: If your daughter is physically unable to play because of an injury, a pro-rated refund will be issued pending director approval. For year long members, as of June 15th, there are no refunds as the season is well more than half over. For half year members in the fall, as of November 1st, there are no refunds. In all cases, PHYSICAL injury is the ONLY reason for a refund!

* I / We, being a parent or legal guardian of this Player, understand and accept the risk of injury is possible while playing the sport of lacrosse. I agree on behalf of myself, my heirs, and personal representatives, that Queen City Stars, together with coaches, officials, volunteers, agents, officers and directors of the Laxcharlotte, Inc. and any such sponsors shall not be held liable for any injury, loss of life or other loss or damage as a result of participation in any Queen City Stars events.

Electronic Signature - Please Enter Parent/Guardian 1's First and Last Name

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