2017 Team BC Female Midget/Bantam Box Lacrosse Program

Registration Form - Provincial Tryout Camp


PAYMENT AND REGISTRATION DEADLINE: Thursday, May 4, 2017 to BCLA Office by 4:00 PM

For more information, please E-Mail: dave@bclacrosse.com

Player Application Form

C O N T A C T     I N F O R M A T I O N

Player First Name

Player Last Name

Parent/Guardian First Name

Parent/Guardian Last Name

Street Address


Postal Code
V1V 1V1


Email Address

Phone (Home)
(xxx) xxx-xxxx

() -

Phone (Work)
(xxx) xxx-xxxx

() -

Phone (Cell)
(xxx) xxx-xxxx

() -
C U R R E N T     P L A Y E R   I N F O R M A T I O N

Name of Box Association



Date of Birth - (mm/dd/yyyy)

(in feet and inches)
ie. 5ft. 5in.

ft. in.

(in pounds)
ie. 150 lbs.


Dominant Hand

Goaltender (Yes/No)

T-Shirt Size
(Male Adult Sizing)

P A Y M E N T     M E T H O D

Payment Method

Security Code:

You will be re-directed to either Moneris or Paypal
to complete payment for your registration