Breakers Lacrosse Club Virginia

Thank you for choosing to spend your summer on the field with Breakers Lacrosse Club Virginia! After completing this registration please submit your payment via PayPal to @breakerslaxva. Please note that payment plans are not available for HS Girls Showcase or 2029 Boys teams.

If you need assistance or have any further questions, please contact Ryan Shaw, Executive Director, at breakerslcva@gmail.com or 757-301-1397.

It's going to be a great summer and we are glad you are going to be a part!

* indicates required

Player Name *

Birthday (DD/MM/YYYY) *

School and Graduation Year *

USALacrosse Member ID and Exp *

Desired Jersey Number (List 3 Options) *

Uniform Size (HS Girls Showcase & Boys 2029 Only)

Parent Name(s) *

Email Address *

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number *

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