Capital Centre - The Summit

Indoor Lacrosse League/Learn To Play Registration Form

Mail To: The Summit, Lacrosse League, 9410 Davis Hwy. , Dimondale, Mi. 48821   

or  FAX: 517-319-1004

Name___________________________________________________ DOB _________ Grade _____

Address ______________________________City ______________________  ZIP _____________

Phone (H) _______________(W) ______________ (C) _________________

EMAIL ______________________________________ GENDER (Circle One)   MALE      FEMALE

(Circle enrollment choices) Summer Session - "Learn To Play" $100

Fall/Winter LEAGUE AGE DIVISIONS - $75 per person (Fall/Winter Teams $750)

1st-3rd gr(COED); 4th-6th(COED); Gr.7-9 Boy/Girl; High School (Age 15 up) Boy/Girl

Session 3 - Tues, Thurs - 3 on 3, ( April 17 thru May 22) Individual Sign Up Only

Credit Card #__________________________ Exp. ______  Check or M.O. # ____________

Name on C.Card _________________________________________________

Check Amount ________________ Check Number ____________________

WAIVER/RELEASE Must be signed before participation - EMAIL to receive printable copy: betsysmith@capitalcentre.com