Girl's Lacrosse Camp Registration

(*) denotes required information.
A $200 non-refundable deposit must be received by the lacrosse camp office in order for this registration to be activated.

Camper Information:
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip:
* Phone:
Email:
* Age:
* Date of Birth:
* School:
* Grade in 2012-13 School Year:
* Select your position:
A M D G
Years Playing Experience:

Roommate Request:
Please type in a name if you have a preference.

* Select your reversable pinney size (adult size):
S M L XL

Medical Consent:
In the event of an emergency, please list two people we can contact:
* Primary Contact:
* Relationship to Camper:
* Phone Number:
Secondary Contact:
Relationship:
Phone Number:

* Does the camper have any known food or drug allergy:
Yes No

* Does the camper have any ongoing disease, physical disability or recurring illness that may affect or impair participation in this camp?
Yes No
If yes, please send a physician's note describing the disability and specific limitation for participation.

Insurance Information:
* Insurance Company:
* Policy Number
* Phone:
Address:
City:
State:
Zip:

Gettysburg College