3rd Annual ML/BT Boys/Girls Laker Lacrosse Camp
Child's Name_______________________________________T-Shirt Size__________________
Grade(During registration)______________D.O.B.___________________M/F______________
Allergies______________________________________________________________________
Parent's Names_________________________________________________________________
Address_______________________________________________________________________
E-mail Address_________________________________________________________________
Cell Phone #___________________________Home Phone #____________________________
Family Physician____________________________________Phone
#_____________________
Emergency Contact__________________________________Phone #_____________________
Please Select Session:
____Camp/Grades 2-6
____Little Lakers/Ages 4-7
9am-1pm
9am-11am
Parental Release
I, the undersigned, being the parent or legal guardian of the above-named child, do hereby grant permission for participation
in the Mountain Lakes Lacrosse Camp sponsored by the Mountain Lakes Recreation Commission. I assume all risks and hazards
incidental to such participation and release the Mountain Lakes Recreation Commission and its agents and assigns form any
liability and/or responsibility for any injuries sustained by my child or expenses incurred therefrom while engaged in or
traveling from any activities of the above-named organization.
Signature of Parent/Guardian____________________________________Date______________
___I grant permission for Laker
Family Camp to use my child’s pictures for the camp’s website photo gallery.
