Age Category Exemption Request

Age Category Exemption Request
Athletes Name*

First NameLast Name
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Phone Number (Optional)
Please enter a valid phone number.
Current Club*

North Winnipeg FalconsEast Winnipeg GryphonsSouth Winnipeg SidewindersWest Winnipeg ShamrocksEastman WizardsOjibway NationalsCarberry CrushNeepawa NoizeWheat City WranglersInterlake StormSouthman SaintsThompson Lacrosse
Gender*

MaleFemale
Athlete's Height*
Athlete's Weight*
How many seasons has the athlete played lacrosse?*
Is the athlete a goalie?*

YesNo
Current Age Category*

u7 / u9u11u13u15u17u22
Requested Age Category*

u7 / u9u11u13u15u17
Reason for Exemption Request*
Today's Date*

MonthDayYear
Date
Athlete Signature*

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Parent/Guardian Name (If under 18)

First NameLast Name
Parent/Guardian Signature

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Should be Empty: