Off-Season Elite Program Registration Form

Parent/Guardian Details

Parent/Guardian 1 Name *

Parent/Guardian 2 Name

Contact Email*

Contact Email 2

Phone (+61 XXX XXX XXX)*

Additional Phone (+61 XXX XXX XXX)*

Player First Name*

Player Last Name*

Birthday*

Day

Month

Year

Age as of 01 October*

Player Details

Position (select all that apply)*

Goalkeeper

Defense

Midfield

Attack

Long Stick Midfield (LSM)

Short Stick Defensive Midfield (SSDM)

Other

Dominant hand*

Left

Right

Team/Club

Which club are you registered at?*

Altona

Brunswick

Camberwell

Caulfield

Chadstone

Eltham

Footscray

Malvern

MCC

Melbourne University/High

Surrey Park

Williamstown

Wyndham

Other

Price: $300 (including GST). Invoice will be emailed.

I am a part of the Sandstorm Team.

I agree to be contacted by the Melbourne Lacrosse Academy.

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