2023 Senior A Player Registration Form

First Name *

Last Name *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Date of Birth *

Instagram Handle

Emergency Contact Name *

Emergency Contact Phone *

Primary Position *

Forward
Defense
Faceoff
Goalie

Dominant Hand *

Left
Right

Jersey Size *

T-Shirt Size *

Short Size *

Preferred Jersey Number(s) *

Add up to 5

Do You Need a Box Lacrosse Helmet? *

Please note: box lacrosse helmets are required by our league. Depending on responses, we may look into a bulk order for helmets.

Height *

Weight *

College Attended *

Nationality *

If 'Other', Please Specify *

Do you coach or are otherwise involved with any area youth programs or school? If so, which ones? *

We want to get youth to come to our games. Knowing which programs you're affiliated with helps with that.

Please submit your favorite game photo of yourself in Portagers, National Team, Juniors, or collegiate gear

Drop your file here or click here to upload

Do you have any other talents or interests we should be aware of? *

As an organization, we want to provide opportunities for our players to growth both on and off the field. By answering the above question, we're attempting to connect interests with opportunities. For example, if you're interested in lacrosse gear, we may have an opportunity for you to host an equipment review show on The Box Lacrosse Channel.

I have read and agree to the Player Agreement *

I have read and agree to the Code of Conduct *

Signature *

Player Registration Fee *

Price: $ 250.00

Total

-360

If you've been provided with a discount code, please enter it here

x

I'd like to pay via a payment plan *

Yes
No

By selecting "Yes", after submitting this form you will be automatically redirected to a new page which will allow you to pay your Player Dues via Afterpay. Afterpay is a by now, pay later service that allows you to pay your dues over time. Afterpay is a free service when you pay on time - there are no upfront fees charged, no interest charged, and it won't affect your credit score. Learn more at afterpay.com. By selecting "No", you can pay by credit card now directly in this form. How convenient!

Credit Card