Le Moyne College Lacrosse Camp Overnight Registration Form

Mail Completed Forms & Payment (Full or deposit) to:
Champions Choice Lacrosse Camps
Attn: Dan Sheehan
Le Moyne College
1419 Salt Springs Road
Syracuse, NY 13214
Phone: 315-445-4463; Fax: 315-445-6015

2010 Printable Camp Registration Form
Please Print Clearly

Name: ____________________________________________________________ Date________

Address:______________________________________________________________________

Home Telephone #: ___ - ________________ Age: __________ Grade Completed: ____________

School District: _________________________ Years Experience: ________ Ht. _____ Wt. _____

Roommate Preference(one): _____________________ E-Mail Address: _____________________

Please Circle Choice

Position

Att - Mid - Def - Goal - No Exp

Jersey Size

Small/Med.(or)Large/XLg.

CCLAXCAMPS Hooded Sweatshirt
-Youth Large
(Adult Sizes)
-Sm. - Med. - Lg. - XL - XXL

July 11-14

Day - Overnight - Team Discount $10

*Make Checks payable to: Champions Choice Lacrosse Camps

* Please see: Information page for additional pricing details

AUTHORIZATION FOR MEDICAL TREATMENT OF MINOR

I hereby certify that _______________________________is in good health and may participate in all camp activities including swimming. I hereby consent to emergency medical treatment by Dan Sheehan, Director of the Champions Choice Lacrosse Camp, or camp trainer to act in my behalf in authorizing emergency medical attention beyond that maintained by the camp. I hereby waive and release the camp from any and all liability for injuries incurred while at camp or arising from travel to and from camp. Camp will not be responsible for medical costs. I also give Champions Choice Lacrosse Camp permission to use, at their discretion, any camp photos.

Camper Name: __________________________________

Insurance Company Name: _________________________

Parent/Guardian Signature: __________________________

Insurance ID#: ___________________________________

Telephone #: ____________________________________

Primary Physician & Phone: ________________________

2010 Printable Camp Registration Form Please Print Clearly

2010 Printable Camp Registration Form
Please Print Clearly