COACHING STAFF
Justine Button is the
new coach at Virginia
Episcopal School.
She is a 2003 graduate
of Holy Cross, where
she played four years of
NCAA Division I lacrosse
and two years of Division
III ice hockey. As a senior at Holy Cross, she was
selected as the offensive player of the year for
the lacrosse team and ranked among the team’s
leading scorers for three of her four seasons.
She was also an all-Patriot League academic
selection. After graduating from Holy Cross, she
became the head coach at NCAA Division III
King’s College and led King’s to one of its best
seasons in school history.
Alexis Wagner is the
head women’s lacrosse
coach at NCAA Division
III Randolph College.
Wagner has coached at
both the college and
high school level in her
coaching career. She
served as assistant coach
at Merrimack College
in Andover, Massachusetts from 2004-2007. At
Merrimack, Wagner assisted in all phases of the
women’s lacrosse program including organizing
and coaching practices, scouting opponents, and
recruiting potential student-athletes. Wagner was
instrumental in leading the Warriors to becoming
a national power at the Division II level. During
her three seasons as assistant coach, Merrimack
became nationally ranked for the first time in
school history and broke over 16 school records.
Wagner also coached four second team AllAmerican players at Merrimack.
JAB Lacrosse
2 0 1 1 Regist ration
Name: __________________________________
What: Winter Lacrosse Training
The focus of our winter training sessions will be on getting
ready for the spring season- stick skills, shooting, small
game play and speed training.
Address:_________________________________
JAB Lacrosse Club is a new lacrosse organization
in Lynchburg, Virginia that will provide opportunities for girls to play lacrosse in the fall, winter and
summer months. Our goal is to expose girls to the
amazing game of lacrosse and inspire them to be
confident, strong and dedicated athletes.
Parent(s) Names:__________________________
City:________________State/Zip:____________
Phone (H):____________(C)________________
E-mail:__________________________________
Emergency Contact:________________________
Emergency Phone:__________________________
U.S. Lacrosse Number:_______________________
*Athletes must be a member of U.S. Lacrosse to participate
Grade:____________Age_____
Where: Virginia Episcopal School Lacrosse Fields/Indoor
Gym
When: Sunday- Nov. 20th, 27th
Sunday- Dec. 4th, 11th
Sunday - Jan. 1st, 8th, 22nd, 29th
Optional tounament: January 14th at Lynchburg College
School:____________________________________
Years Played:________________________________
Playing Level (circle one): Beg.
Int.
Adv.
Insurance Form
Coverage for accidental injury is required by all participants. In most cases, family health insurance is adequate,
however it is up to the guardians of the participants to
determine this. Participants will not be allowed to play
unless the following information is submitted and the form
is signed by the parent or guardian of the participant:
Time: 5:00 PM - 7:00 PM
Health Insurance Company ___________________
Policy Number____________________
Cost: $120 Practice fee (full payment is due with your
registration)
Emergency Medical Treatment Authorization
I (we) the undersigned, hereby certify that I (we) are the
parent or guardian of the participant and hereby give
permission to JAB Lacrosse and the training staff to seek
appropriate medical attention as necessary to insure the
wellbeing of my (our) daughter.
Equipment: All players must bring all personal equipment
including goggles, sticks, water bottles and mouth guards.
Who can participate? All girls, 9th-12th graders
Registration Deadline: November 18th—registrations
will not be accepted after this date.
Registration: Fill out the form at right, tear it off and send
it to:
Justine Button
JAB Lacrosse
400 VES Road
Lynchburg, VA 24503
E-mail: [email protected]
Phone: 434.851.0703
www.jablacrosse.com
Parent/guardian signature _______________________
Date _______________________________________
Waiver & Release
I (we) the undersigned, for ourselves, our heirs, executors,
and administrators, waive, release and forever discharge the
Training staff, officers, agents, employees, representatives,
successors, and assign of and from all rights and claims
for damages, injuries, or loss of person or property, which
may be sustained or occur during participation of camp
activities, whether or not damages, injury, or loss is due to
negligence.
Parent/guardian signature ________________________
Date ________________________________________