Mail Completed Forms & Payment (Full or deposit) to:
Le Moyne College Lacrosse Camp
Le Moyne College
Salt Springs Road
Syracuse, NY 13214
Phone: 315-445-4463; Fax: 315-445-6015

2008 Printable Camp Registration Form

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.

Le Moyne Lacrosse Hooded Sweatshirt
-Youth Large
(Adult Sizes)
-Sm. - Med. - Lg. - XL - XXL

July 13-16

*Day(300) - Overnight(385) - Deposit(185)

*Make Checks payable to: Le Moyne College Lacrosse Camp

* 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 Le Moyne College Lacrosse Camp, or 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 Le Moyne College 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: ________________________