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