Welcome

Welcome to the Spring 2025 with Southwest Washington Lacrosse

This registration session will allow you to complete contact information, sign up for participation, and submit payment. Please read through each page carefully to ensure that all information is provided accurately. To complete registration, please fill out all the information and we will collect payment within the next few weeks.

USA LACROSSE REQUIREMENT

You must register first with USA Lacrosse and then return to this Registration Session to signup. If you have not already signed up with USA Lacrosse, please follow these steps:

Step 1: Obtain a USA Lacrosse Membership

Step 2: Return to this registration and proceed. Later in this registration session you will need to enter the USA Lacrosse Membership ID that you received in Step 1.

Code of Conduct

Players, coaches, officials, parents and spectators must conduct themselves in a manner that honors the game of lacrosse.

SCA Awareness Act:

Please click this link and read the information on Sudden Cardiac Arrest.

Registration Form

USA LACROSSE MEMBERSHIP VALIDATION

USA Lacrosse Member Number

Player Name

Date of Birth

PLAYER & GUARDIAN INFORMATION

First Name

Last Name

Age As Of January 1st

Gender

Grade

School

Guardian First Name

Guardian Last name

Guardian Phone Number

Guardian Email

Guardian 2 First Name

Guardian 2 Last name

Guardian 2 Phone Number

Guardian 2 Email

Primary Emergency Contact Name

Primary Emergency Contact Email

Primary Emergency Contact Home Phone

Primary Emergency Contact Relationship To Player

Secondary Emergency Contact Name

Secondary Emergency Contact Email

Secondary Emergency Contact Home Phone

Secondary Emergency Contact Relationship To Player

Medical Insurance Company

Medical Insurance Policy Number

Medical Insurance Policy Holder

Physician's First Name

Physician's Last Name

Hospital Of Choice

Does the player have any allergies that we need to be aware of?

Yes

Allergies Details

Does the player have any medical conditions that we need to be aware of?

Yes

Medical Conditions Details

I/we have read, understand and agree to comply with parent/guardian consent and medical release as outlined above.

Parent/Legal Guardian Signature

Sign Here

HEADS UP CONCUSSION WAIVER

I learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury.

Athlete Signature

Sign Here

I have read this fact sheet for parents on concussion with my child or teen and talked about what to do if they have a concussion or other serious brain injury.

Parent/Legal Guardian Signature

Sign Here

CONSENT TO MEDICAL TREATMENT

If the above named participant needs emergency medical treatment and neither parent nor the family doctor can be reached, consent is hereby granted for such emergency treatment as may be considered necessary in the opinion of the attending physician.

I/We have read, understand and agree to comply with the Parent/Guardian Consent And Medical Release as outlined above.

Parent/Legal Guardian Signature

Sign Here

Questions?

Please direct any questions regarding this registration to:

Jenifer Johnston
[email protected]