PARENT/GUARDIAN INFO
Camp Attending: *required Mini Camp 1: 6/30-7/3 $225 Overnight: 7/7-7/10 $415 Mini Camp 2: 7/28-7/31 $225
medical form
Camper's Last Name: *required
Camper's First Name: *required
Street Address: *required
City: *required State: *required
Email: *required
Home Phone: *required
Parent Cell: *required
Weight: *required Height: *required
Grade entering 9/2014: *required
School District: *required
Position: attack midfield defense goalie *required
T-Shirt Size: Youth L Adult S Adult M Adult L Adult XL
Roommate request:
Name/Relationship *required
Contact number: *required
Emergency number: *required
Insurance provider: *required
Insurance ID#: *required
Primary Care Physician: *required
Primary Care Ph#: *required
AUTHORIZATION FOR MEDICAL TREATMENT
I, *required here certify that, *required, is in good health and may participate in all camp activities, including swimming. I hereby consent to emergency medical treatment by Champions Choice Lacrosse Camp (CCLC) personnel or by camp trainer acting on there behalf in authorizing medical attention beyond that maintained by the camp. I hereby waive and release the camp from any and all liabilities for injuries incurred while at camp or arising from travel to and from the camp. Camp will not be responsible for medical costs. I also give CCLC permission to use, at their discretion, any camp photos. *required