Arlington County Department of Parks, Recreation and Cultural Resources (PRCR)The Sports and Recreation Division

3700 South Four Mile Run DriveArlington, Virginia 22206

703-228-1801 / 703-228-1825

ROSTER SUMMARY SHEET

Organization Name: Arlington Youth Lacrosse Club Applicant Name: Jon Cunha

Sport: Lacrosse Season: Spring 2014

Please provide information on the number of registered participants:

Total Number of Players CALCULATION OF ASSESSMENTAGE PLAYERS TOTALS

Female Male County ASSESSMENT4 0 0 0 0 Per Participant5 2 5 76 10 29 39 449 x $8.00 $3,592.00 7 18 36 54 Total Participants8 12 32 40 49 23 43 62 4

10 24 57 80 1 NON-COUNTY ASSESSMENT11 26 34 6012 17 31 48 9 x $20.00 $180.00 13 17 27 4414 1 13 1415 3 1 TOTAL DUE TO ARLINGTON COUNTY1617 $3,772.00 18

Adults CHECKS MADE OUT TO:

150 310 449 9 TREASURER, ARLINGTON COUNTYCheck No:

Female Male Coed MAIL TO:

8 16

Number of Scholarships Provide 4

$ Amount of Scholarships Provi $ 760 $

www.arlingtonva.us/prcr

Non-County

TOTAL PLAYERS

Total Number of

Teams

PRCR - (STAFF LIAISON NAME)3700 S. FOUR MILE RUN DRIVEARLINGTON, VA 22206