INSTRUCTIONS:    PRINT FORM - FILL OUT - SEND TO ADDRESS AT BOTTOM WITH PAYMENT

NAME(PLEASE PRINT)_____________________________________________________________

ADDRESS____________________________________________________________________________

CITY_____________________________________________STATE_____ZIP_________________

PHONE # (____)_________________   EMAIL:_____________________________________

AGE________DATE OF BIRTH______/______/______ HEIGHT________WEIGHT_______

POSITION:   ATTACK___   MIDFIELD___   DEFENSE___   GOALIE___   YEARS PLAYED_____

SHIRT SIZE(CHECK ONE):  SMALL____   MEDIUM____    LARGE____    X-LARGE____

WAIVER RELEASE:    FOR GOOD AND VALUABLE CONSIDERATION, RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED, WE THE UNDERSIGNED, FOR OURSELVES, OUR HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE, RELEASE AND FOREVER DISCHARGE SEATTLE LACROSSE CAMP, IT'S STAFF, OFFICERS, AGENTS, REPRESENTATIVES, EMPLOYEES, SUCCESSORS OF AND FROM ALL RIGHTS AND CLAIMS FOR DAMAGES, RESULTING FROM INJURY OR PROPERTY WHICH MAY BE SUSTAINED OR OCCUR DURING PARTICIPATING CAMP ACTIVITIES OR ARISING FROM TRAVEL TO OR FROM CAMP, WHETHER SAID DAMAGES, INJURY OR LOSS ARE DUE TO NEGLIGENCE OR NOT.

APPLICANT'S SIGNATURE__________________________________________ DATE ________

PARENT / GUARDIAN SIGNATURE_____________________________________ DATE ________

HEALTH INSURANCE COMPANY_______________________________ POLICY#_____________

PAYMENT and REFUND POLICY: All registrations must include a non-refundable down payment of $80.00. The remaining $100.00 is due the morning of the first day of camp.

A Camp Packet with comprehensive details will be sent out, upon receipt of a fully paid registration Check-in: first day of camp from 8:00 until 9:00AM