My my My my
Upper Perk Girls Lacrosse Youth Program
Spring 2014

WHO:           3rd -6th grade girls     
Upper Perkiomen High School
                      2 Walt Road, Pennsburg, PA  18073
COST:           $100 New players- includes uniform, insurance, officials, & tournament fees
                      $70 Returning players – includes insurance, officials, & tournament fees
                              (only if you can use your uniform from last year)
WHEN:          Practice from 6-7:30pm   2-3 days per week        Games on Saturdays
EQUIPMENT:  You will need your own stick, ball, gogglesand mouth guard  (goggles may be signed-out if needed)

Please make check payable to "Upper Perk Lax Club"

Print this form and mail with check  to:   Jenny Boyer 438 3rd St, East Greenville PA 18041 

REGISTER by Feb 12, 2014 Direct questions to Niccole at  or Shannan at 

Player name: _______________________________ Name of parent/Legal guardian:________________________

Current Grade ______                                                               Returning players – list your uniform number _____

                New players      Shirt Size (circle) youth:   YS    YM    YL   adult:  AS    AM     AL

                                          Short Size (circle) youth:   YS    YM    YL   adult:  AS    AM     AL

Address: _____________________________________________________________________

 Parent Phone: _________________________               Parent phone: ______________________ 

 Email: ______________________________   Medical conditions/allergies: _______________________________

 Emergency Contact Name: ___________________________ Phone :________________________

 Picture Release: I will allow Up Lax Club to use any pictures of my child from this event in local publications or on the UPLacrosse website.    Yes ____               No ___

Insurance Waiver/Hold Harmless Clause
The Upper Perkiomen Youth Lacrosse Program is made up solely of volunteers with the purpose of teaching the youth of the Upper Perkiomen Valley about the basic skills of lacrosse. There is no form of medical insurance coverage provided for the participants of this league. By registering, the parent/guardian of the participant agrees to hold harmless all volunteers of the Upper Perkiomen Youth Lacrosse Program, all members of the Upper Perkiomen School Board, coaches and administrators for the loss of any material, equipment, and injury which may occur while using the facilities of the Upper Perkiomen School District while participating in the Upper Perkiomen Youth Lacrosse Program. In addition, the parent/guardian and participant agree to hold harmless all parties identified above for all acts of negligence.

Parent/Guardian Signature ______________________              Date _________

Click Here to print out the flyer.