SUSPENDED FORM

Player Name

Player Birthdate

Year player will graduate from High School

Player Email

Player Cell Phone

Address

City

Zip

Current School

Intended High School (for middle school players only)

Position

Please indicate your player's highest level of participation

School/Youth Club Team Coach's Name
Please put N/A if not playing for high school or a youth club.

School/Youth Club Team Coach's Email

T-shirt Size

Player Height

Player Weight (lbs)

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Parent/Guardian 1 Name

Relationship to Player

Parent/Guardian 1 Email

Home Phone

Cell Phone

Parent/Guardian 2 Name

Relationship to Player

Parent/Guardian Email 2

Home Phone

Cell Phone

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Emergency Contact Name

Relationship to Player

Best Phone Number to Contact

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Health Insurance Company

Health Insurance Company Phone

Policy Number

Physician Name

Physician Phone Number

ALLERGIES/OTHER: Please check any and all that your player has had experience with.

If you checked any of the above conditions, please give further details here:
Please put N/A if you checked none.

INJURIES: Please list any and all past or current injuries (sports or non-sports related) including concussions, surgeries, and acute or chronic ailments.
If there are no injuries to list, please put N/A.

Will your player be taking any medications while participating with Bay Area Wave either in practice, competition, or travel?

If you answered yes to the above questions, please list medication(s), dosage, and reasons for taking.

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Participation Waiver

I agree to the terms outlined in the participation waiver.

Current US Lacrosse membership is required for all players who wish to participate with Bay Area Wave Lacrosse Club. To check to see if your player's membership is currently valid or if your player is not currently a member of US Lacrosse, please go to: uslacrosse.org

Player's US Lacrosse Member Number (required):

US Lacrosse Membership Expiration Date: