Special Needs Registration Page

Special Needs Program Registration Form

Thank you for your interest in the LMSC Special Needs 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*
Date Format: YYYY slash MM slash DD
Special Needs Program
COACHING VOLUNTEERS
LMSC is dependent on having parents volunteer to coach. Please consider being a coach for your child's team. We are always especially in need of parents volunteering to serve as head coaches in the 6-12 year old divisions.
Coaching Volunter's Last Name
Coaching Volunteer's First Name
Phone For Coaching Volunteer
E-Mail For Coaching Volunteer
Enter Email Confirm Email
Coaching Preference
- Head Coach
- Assistant Coach
PROGRAM PAYMENT
The cost of the Special Needs Program is $60 per player.

You may pay by check or by credit card. If you choose to pay by check (made out to LMSC), please mail your check to LMSC, Box 360, Bryn Mawr, PA 19010.

There is a 3.3% bank service fee for credit card registrations.
Payment Choice:*
Bank Fee*
Price: $0.00
Total Amount To Be Applied To Credit Card
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Additional Comments
Please feel free to enter any additional comments here: