Summer Lacrosse Camp

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* Indicates required field

Child's Name *

First

Last

Which Session are you registering for *

Session 1: 5th and 6th grade Session 2: 3rd and 4th grade

What grade will your child be in (25-26 school year) *

3 4 5 6

Parent/Legal Guardian Name *

First

Last

Primary Phone Number *

Work Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency contact Name (other than yourself) *

First

Last

Emergency Contact Phone Number *

Please list any medical conditions/limitations that we should know about, including any allergies *

Participation in this program may involve risk of injury. As a parent, guardian or participant, I am aware of these hazards and my child’s ability to participate. In consideration for participation in the program listed above, I hereby for myself, my heirs, executors and administrators waive and release all rights against the Gilford Youth Center, Lakes Region Elite, its officers, employees, agents, volunteers, and supervisors, except in the case of their sole negligence, from all losses, injury, damages, fees, and other expenses, arising out of or in connection with participation in the program and activities. In addition, I give my permission for the child to be treated by qualified medical personnel in the event that the above named parent/guardian cannot be reached at the phone numbers provided. As a parent, guardian or participant, I allow the Gilford Youth Center to take my child’s picture/video for advertising and promotional purposes * *

I agree to the terms listed above

Your Name *

First

Last

Camp Information

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