Falcon Lacrosse Camper
Registration
Full Name
Fill out the registration form below and click submit
Home Address
City
D.O.B.
Grade Entering
Parents/Guardians
Years Experience
State
Zip
School
Position
Phone 1
Phone 2
Email
Insurance Information
Falcon Lacrosse Camp is fully insured. Each camper must also procide their own medical insurance. The camp only provides coverage in excess of the individual's policy.
Insurance Company
Name on Policy
Policy Number
Address
Doctor Information
All Campers are required to submit their doctor's information with registration.
Doctor
Phone
Address
Special Medical
Info
Parent Signature
I hereby give permission for my child to be treated for his illness during his stay at Falcon Lacrosse Camp. However, no treatment shall be administered by a doctor or a hospital without parents being contacted, unless for an emergency. I am also aware that certified athletic trainers will be available at all times during Falcon Lacrosse Camp.
By typing my name and date below i agree to the above declaration.
Parent/Guardian Signature
Date
$385 per session
Session 1: Sunday - Wednesday (7/10-7/13)
Session 2: Wednesday - Saturday (7/13-7/16)
Session
After you submit the registration information, the payment can be done through Paypal or by sending a check to the address below:
Peter Milliman
Falcon Lacrosse Camp
Box 960
Pfeiffer University
Misenheimer, NC 28109
please feel free to email us with questions.
