2019 Little Rhody Lacrosse Camp Registration

2019 LITTLE RHODY LACROSSE CAMP - REGISTRATION & PAYMENT

* Indicates required field

Participant Name *

First

Last

Age (as of 6/23/19) *

Grade (entering Fall '19) *

Position *

Experience *

Reversible Jersey Size *

Parent(s) Name *

Parent Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Parent Cell Number *

Cell Phone for Text Alerts (if different from Parent Cell) *

Insurance Carrier *

Insurance Policy Number *

Participant Health Issues *

Emergency Contact *

Emergency Contact Phone *

LIABILITY WAIVER

I represent that I am the parent and/or legal guardian of the child named below and hereby give my permission for my child to participate in any and all activities at the 2019 Little Rhody Lacrosse Camp "Camp" at Roger Williams University "University". I agree to assume all risks associated with my child's participation in the Camp including but not limited to, risk of bodily injury, death, and / or property damage. In consideration of my child being permitted to participate in the Camp, I agree to release, indemnify, and hold harmless the University & Little Rhody Lacrosse, LLC, its trustees, directors, officers, employees, students, contractors, volunteers, affiliates, and agents, from any and all claims that I or any third party might have as a result of my child's participation in the Camp. I give my consent for my child to receive emergency medical treatment in the event that my child becomes ill or is involved in an accident during the Camp. I understand that I will be notified at the emergency telephone number provided on this form in the event of an emergency involving my child.

Waiver Approved By *

Payment Option *

Credit Card Check

By clicking SUBMIT button below, your registration information will be submitted and you will be directed to different page for payment instructions.

Payment can be made via credit card (Visa, MasterCard, American Express or Discover) or via check.

Please note that spot in CAMP is not guaranteed until payment has been received.

SUBMIT