LAX4LIFE
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Summer Camp Registration
*First name
*Last name
*Address
*City, State Zip
*Home Phone Number
*Cell Phone #
*Email
*Parent(s) Name(s)
*Emergency Contact & Phone #
*Camp Location
-Select a choice-
Irondequoit
Victor
Webster
*Type of Camper
-Select a choice-
Full Day
Morning Camper
Afternoon Camper
*Age
*Division
-Select a choice-
1 (Entering 8th & 9th Grade)
2 (Entering 5th, 6th, or 7th Grade)
3 (Entering 2nd, 3rd, or 4th Grade)
*What size jersey (youth)
-Select a choice-
S
M
L
XL
*I give consent for my son to participate in all activities for the LAX4LIFE camp. Further, I authorize the coaches that are trained in First Aid and CPR to act for me according to their best judgement in any emergency.
Yes
No
Allergies
Comments
I give permission for my son to be photographed or videotaped for promotional ads.
Yes
No
*I understand that there is a $100 non-refundable deposit included in my payment
Yes
Once you have completed this form and have clicked submit, please click on the
Make a Payment
link to make your payment by credit card. Payment must be received before 5/1/10 to qualify for the early registration fee discount of $30 and by 6/1/10 for the discount of $25.