Beginner's Clinic Registration | NKY Pulse Lax

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Beginner's Clinic Registration ($125)

Player Information

Player's First Name

Player's Last Name

Birthday

Player Email (Optional)

School

Graduation Year

Address

Player health conditions

Asthma

Allergy (anaphylactic)

Diabetic

Heart condition

Seizures

Other

Parent Contact Information

Parent's name

Parent's Email

Parent's Phone

Consent & Liability Release

I have read and agree to the release of liability and waiver form as it relates to my daughter (specified in entry one of this registration form) .View release of liability

Parent Signature

Program Fee *

Beginners Clinic - $125

Thanks for joining Pulse Lacrosse!

Watch your emails for more information leading up to the first practice.

Email us at: northernkentuckypulse@gmail.com

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