Fall Intramural Program Registration Form

Thank you for your interest in the LMSC Fall Intramural Program. Please register your child in the form below. If there is a coaching volunteer associated with this child, please register that person below in the Coaching Volunteer section.
Child's Last Name*
Child's First Name*
Address*
Street Address City State ZIP Code
Phone*
Primary E-Mail Address*
Enter Email Confirm Email
Second E-Mail Address (Optional)
Enter Email Confirm Email
Parents' Names*
Gender
- Male
- Female
- Other
Birthdate*
YYYY slash MM slash DD

PROGRAM PAYMENT
Payment by credit card includes a $5.00 bank service fee.

If you signed up for the 2020 Intramural Program and are owed a credit due to Covid-19, please indicate that in the "Payment Choice" section below.
Payment Choice:*
Bank Fee*
Price: $0.00
Total Amount To Be Applied To Credit Card
$0.00
Credit Card
Card Details
Cardholder Name
Additional Comments
Please feel free to enter any additional comments here:
IMPORTANT NOTE: Please click on the SUBMIT button to enter your registration. You should recieve an e-mail confirmation within two minutes of clicking on the SUBMIT button, confirming your registration.

If you do NOT receive a confirmation e-mail, please IMMEDIATELY e-mail LMSC right away at soccer@lmsc.net