Clinic Registrations

Registration Form for the H.I.L. Free Clinic held in Orange County

PLAYER INFORMATION
Name*
First Last
Gender*
Date of Birth*
Date Format: MM slash DD slash YYYY
Grade Entering*
Position
School*
Years Played
Lacrosse Equipment you have*
PARENT/GUARDIAN INFORMATION
Name*
First Last
Email*
Enter Email Confirm Email
2nd Email*
Enter Email Confirm Email
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone
Emergency Contact #*
WAIVER RELEASE: My child is in good health and has my full permission to participate in a vigorous lacrosse program. My child has no previous sickness, illness, disease or bodily injury that is contradictory to participation. I fully understand that lacrosse is a contact sport and that physical injury may occur during the course of practice and games. In the event that I cannot be reached I give my full permission for such medical procedures as may be deemed necessary by an examining physician. I also understand that Hi-Impact Lacrosse, Inc. is not responsible for the loss of any personal items and all registrations are NON-Refundable unless a medical emergency in which a signed doctors note is required.*
- I agree
CAPTCHA
Camp Info
Registration Type*
- TRY-IT Day
Coupon

PLAYER INFORMATION