Just 4 Girls Lacrosse

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Miller Place Summer Camp 2019 registration (Please Click Here)

PLAYER INFORMATION

* First Name:

* Last Name:

* Shirt Size:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Grade:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

WAIVER INFORMATION

WAIVER AND RELEASE: (must be completed by each player) I, the undersigned, agree that I and/or (my daughter) am physically fit to participate in strenuous athletic activity,and waive Just 4 girls lacrosse, Dowling College, Project Heal and employees of any and all responsibility for injury or illness. I hereby authorize the directors of Just 4 Girls lacrosse to act for me according to their best judgment in any emergency requiring medical attention. I also understand that I am solely responsible for the payment of any such medical expenses.

I/we agree with the above *

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Miller Place Summer Camp 2019 registration (Please Click Here)