Girls Lacrosse

$ Donation Amount:

Please adjust for multiple players

Plus an additional to cover gateway fees.

First Athlete Name

Second Athlete Name

Third Athlete Name

Select Payment Method

Offline Donation
Stripe – Credit Card

Personal Info

First Name *

Last Name

Email Address *

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Donation Total: $250.00

Lax Clinic Registration 2025

"*" indicates required fields

Parent Name*

First Last

Parent Email Address*

Enter Email Confirm Email

Parent Phone*

Player's Name*

First Last

Player's Home Address*

Street Address Address Line 2 City State ZIP Code

Phone

Enter Number here if you’d like to receive text updates regarding the Clinic

Preferred Clinic Group*

Grades 1-2

Grades 3-4

Grades 5-6

Grades 7-8

Player Age at Time of Clinic*

Player Grade*

Primary Emergency Contact*

First Last

Primary Emergency Contact Phone*

Mobile Phone is Preferred for Emergency Contacts

Secondary Emergency Contact*

First Last

Secondary Emergency Contact Phone*

Mobile Phone is Preferred for Emergency Contacts

Medical Information

Does your child have any ALLERIGES or other medical conditions that we need to be aware of? Please include any food ALLERGIES or sensitivities.

Authorized Pickup

Please identify any additional persons who you permit to pick up your child.

Other Pertinent Information

Please provide any other pertinent information regarding your child we should be aware of during the clinic.

Yorktown Girls Lacrosse

Player Details

Lax Clinic Registration 2025

Yorktown Girls Lacrosse

Player Details

Lax Clinic Registration 2025

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