Middlebury Youth Lacrosse Club

Select Team

Boys    Cubs (3rd/4th)            Cats (5th/6th)            Club Midd (7th/8th)
Girls     Lady Cubs (3rd/4th)     Lady Cats (5th/6th)     Ladies Club Midd (7th/8th)

Player Information

Last Name:      First Name:      Nickname:   

Birthday:         Grade:            Home Phone:

May we print the player's name and phone number on the team roster? Yes   No

Custodial Parent(s) (Primary, if applicable): Last Name:   First Name(s):

Home Phone:       Work Phone:   Cell Phone: 

Address of residence:

Street Address:

Town:                State: Zip Code:

Mailing Address (if different):

Street Address:

Town:                State: Zip Code:

Primary Email Address:   

Health Concerns:

Parents, please note:  While MYLC wants to be responsive to individual situations, parents are responsible for informing coaches and being present to oversee special health care concerns.  MYLC cannot be responsible for individual assessments and treatment.

Emergency Contact:

Name: Relationship:

Phone: Address of Residence:

Volunteer Opportunities: Parents are obligated to help in at least one area (check at least one way that you can help)

Team Parent Coordinator Create Phone Tree Create Snack Schedule Organize end of year picnic Coordinate rides to away games Help collect equipment in June Serve on the Board Organize Tournament Food Booth Workers Organize Tournament Raffle

Help with Fundraising Solicit sponsors for tournament Help with Tournament Registration Work a shift at the Tournament Tournament Game Timer Setup Tournament Cleanup after Tournament Other: