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Name:
����_________________________________________Age:_________
School/organization:______________________________________________
Email:_______________________________________________________
Address:__________________________________________________________________________
________________________________________________________________
Phone:__________________________________________________________
What position(s) do you play?
What do you want to
work on? _______________________________________
EMERGENCY CONTACT NAME
AND PHONE #:
________________________________________________________________
I understand the risks of the game of
lacrosse, and I will not hold Oregon State University or the OSU Women�s
Lacrosse Club liable for any injuries that are endured during the clinic
related to the game of lacrosse.
Signature of
Applicant:_________________________________________________
IF APPLCANT IS UNDER 18 YEARS OF AGE:
I give permission for my child to attend
the OSU Lacrosse Clinic. Oregon State University is not liable for any
injuries endured during the clinic.
Signature of parent/guardian:
_____________________________________________
�Registration
Fee: $30(no credit cards)
�Checks
made payable to �OSU Women�s Lacrosse Club�
�Please
mail this form, along with the registration fee, to:
ATTN: WOMENS LACROSSE
204 DIXON
RECREATION CENTER
CORVALLIS, OR 97331
OR:
Email this form, as an attachment, to [email protected], and pay the
fee the day of the clinic.
�Day
of clinic fee: $40
***There will be a $10
no show/cancellation fee***
#: _____________________P
PAID: CASH ( )
CHECK (
) #: __________
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