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2009 Camp Registration Is Officially Open!!!

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2009 Registration Form
Please complete this registration and medical/insurance form. Then please make check payable for full amount: session 1 $200 and session 2 $325 payable to Strong Island Lacrosse Camps. You will receive a confirmation email with instructions where to send check. Please be advised that payment in full is required in order to hold a spot in the camp.

* Required
*Please Select Camp Session

	Strong Island Session 1: BOYS July 27- July 30 Grades K thru 8 – 9:00am to 12:00pm ($200) JFK Middle School, Port Jefferson Station, NY

	Strong Island Session 2: BOYS July 27- July 30 Grades K thru 8 – 9:00am to 3:00pm ($325) JFK Middle School, Port Jefferson Station, NY

*Name
*Address
*City
*State
*Zip
*Date of Birth
*Email
*School
*Age
*Grade
*Position
*Parent Name
*Home Phone
*Cell Phone
*Emergency Name
*Emergency Phone
Medical/Insurance Information
*Name
*Phone
*Family Physician
*Medical/Accident Insurance Company
*Policy #
*Insurance Company Address
*Policy in the name of
Allergies
Date of last Tetanus Shot
*Parent Signature
*Initial	(by typing in your name and initials this becomes a legal document)
I hereby give my permission for a qualified physician, athletic trainer and/or hospital emergency room to administer necessary health care in the case of accident or emergency. I will not hold the camp responsible for any payments beyond their Camp Insurance Program, and will secure adequate family insurance coverage if additional coverage is desired. Emergency name and phone number to be used in the event of an injury that requires emergency treatment when a parent or guardian cannot be reached. I AGREE (check box, then fill out security code) Enter the security code shown below:

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