2010 camp form.pdf

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2010 OSLC Camp Registration Form

Camper Name_______________________________________________Age_______

I like to be called________________________________Date of Birth:___________

School attending this fall________________________________________________ 

Entering Grade_______ Height________ Weight______ 

Years playing lacrosse_____ Position________________

Team(s) you played for in 2010___________________________________________

Parent(s) name(s)_______________________________

Address:______________________________________

City:___________________________State:_____Zip_________

Phone:(H)__________________(C)________________

Parent e-mail:_________________________________

Please describe any health issues camper has that the OSLC staff should        know about: _____________________________________________________________________

Insurance Carrier_______________________________ Policy #_______________

Name of Insured_______________________________ 

Emergency Contact: ____________________________ 

 Phone:(H)______________________(C)________________________

Person(s) authorized to pick up my son__________________________________

_____________________________________________________________________

Special requests______________________________________________________

_____________________________________________________________________

Registration fee- $325 Deduct $25 from fee if your son is a US Lacrosse member

US Lacrosse Member ID # :______________Membership exp. date:___________
                                                                         (must be no earlier than 7/10/10)

Deduct $25 if camper is your second son registered.
Financial aid is available; e-mail jeff@oceanlax.com for  info.

Payment in full is preferred, but a minimum nonrefundable deposit of $150 is acceptable; balance is due by July 6th.

Amount enclosed___________ Amount due___________

Please make check payable to: Ocean State Lacrosse Club & mail with completed form to:  Ocean State Lacrosse Club    88 Aaron Ave.  Bristol, RI  02809             

 Any questions? Call (401) 396-9889                                     www.oceanlax.com