Programs
Program Registration
Welcome to the Lead the Way Online Registration System!

Please note: As a rule of thumb you should never use your Back button or click 'Submit' more than once. Doing so can cause the form to become erased and/or your credit card to be billed more than once.

STEP 1 -

PERSONAL INFORMATION:

Athletes Information :
First Name
Last Name
Date of Birth
Street Address
City
State
Zip
Home Phone
Cell Phone (Optional)
Email Address

Parent/Guardian Information :
First Name
Last Name
Phone #

Emergency Contact Information: (Leave blank if same as Parent/Guardian)
First Name
Last Name
Phone #

School/Coach Information:
Current School
What Grade?
Position(s) Played? (Optional)
Coaches Name (Optional)
Coaches Phone # (Optional)
Playing Experience

PHOTO RELEASE:


I hereby grant Lead The Way Field Hockey permission to photograph my dependent for use in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Lead The Way Field Hockey, in perpetuity, and for other use by the organization. I will make no monetary or other claim against Lead The Way Field Hockey for the use of the photograph(s).

Type the word YES in the box below if you agree. Type NO in the box below if you do not agree

MEDICAL INFORMATION:

Health Insurance Information :
Health Insurance Company
Policy Holder's Name
Policy #
Doctor's Information :
Doctor's Name
Doctor's Phone #
Date of Last Physical

Medical History/Allergy Information : (Please be detailed)