QCMBL - Registration

Wednesday September 08

Vision/Mission

QCMBL Executive

Bylaws & Policy Manual

Coaches

Positive Coaching Alliance

QCMBL Registration
(scroll down for Registration Form)

The following form is placed here for your convenience. It is intended for use by the parents or guardians of players for the upcoming season. Please be sure to complete all fields.

Queen City Minor Box Lacrosse
P.O. Box 27052, 420 Albert Street
Regina, Saskatchewan S4R 8R8
Attention: Registrations
For further info contact QCMBL at wgoebel@accesscomm.ca

Please remember to submit your fee's . Players will not be considered
registered until all fee's have been received at the QCMBL office.

2010 Season - Player Registration Form

* Indicates Required Fields

Member Status:

Pending

Last Name: *

First Name: *

Birth Date: *

e.g. 10-Jan-1995

** Address: *

City/Town: *

Postal Code:

Phone #: *

School Name:

Gender:

Height: e.g. 5.02

Weight (in pounds):

Years Played Lacrosse:

Shoot:

LeftRight

Are you willing to play Goal?:

NoPart TimeFull Time

Years Playing Goal:

Mother's Information
Name:
Address: Same as Player
Or:
Home Phone:
Work Phone:
E-Mail:
Primary Contact:

Father's Information
Name:
Address: Same as Player
Or:
Home Phone:
Work Phone:
E-Mail:
Primary Contact:

Registration & Fees

Registration Type:

Player Registration Fee:
Tyke 2002 & Under - $125.00
Novice 2000 & 2001 - $190.00
Pee Wee 1998 & 1999 - $225.00
Bantam 1996 & 1997 - $235.00
Midget 1994 & 1995 - $235.00
Junior 1989 - 1993 - $240.00

League T-Shirt:

LATE REGISTRATIONS: will only be accepted when the league is able to place players on teams & a $40 late fee will be applied.

**If addresses for parents are different, the player's address will be where the player habitually resides (please indicate this address under Player's information). In cases where the player does not reside habitually with either parent, the player's address will be deemed as the Mother's address. QCMBL reserves the right to require additional proof of address and age.

By submitting this form you agree to the following: WAIVER AGREEMENT

I/We, the Parent(s)/Guardian(s) of the above Registrant, hereby give my/our approval his/her participation in all activities under the jurisdiction of the Saskatchewan Lacrosse Association, its member Associations and lacrosse clubs during the current year. I/We hereby agree that Queen City Minor Box Lacrosse, it executives, coaches, assistants, managers are not responsible for accidents or injuries resulting from participation in any of the Association’s activities. I/We also agree that if my/our child requires any medical treatment during any of said activities and I/We are not present, I/We give permission for coaching management staff to arrange for medical treatment. I/We release Q.C.M.B.L. from responsibility when our child is being transported to and from activities scheduled by the Association/Team.

**REFUND POLICY** All registrations subject to a $40.00 non-refundable administration fee. Refunds will only be issued for medical reasons(with doctors certificate) or the inability of the league to place a player on a team due to lack of coaches/referees.