Soccer Camp Online RegistrationCamp Dates June 13-16th, 2017 Registration Deadline June 2nd, 2017 Camper Information Camper's Full name * Team/Club Only required if registering for the Team discount T-shirt Size - None -Youth SYouth MYouth LAdult SAdult MAdult LAdult XL Age * Gender * Male Female Street Address * City * State * Zip * Camp Choice Session Selection * Pick Individual Sessions Pick Full Day Sessions Morning Ages 5–7 • 9–11 a.m. • $60 Ages 8–16 • 9–11:45 a.m. (individual field player) • $90 Ages 8–16 • 9–11:45 a.m. (goalkeeper) • $90 Ages 8–16 • 9–11:45 a.m. (Team: minimum 8 rostered players) • $80* Afternoon Ages 8–16 • 1–3:45 p.m. (individual field player) • $90 Ages 8–16 • 1–3:45 p.m. (goalkeeper) • $90 Ages 8–16 • 1–3:45 p.m. (Team: minimum 8 rostered players) • $80* Full Day (Bring Lunch) * Ages 8–16 • 9 a.m.–3:45 p.m. (Individual field player) $160 Ages 8–16 • 9 a.m.–3:45 p.m. (Goalkeeper) $160 Ages 8–16 • 9 a.m.–3:45 p.m. (Team: minimum 8 rostered players) $130 Insurance Information Please note any medical conditions that we should be aware of Insurance Provider * Insurance Policy Number * Health And Insurance Information I certify that the applicant is physically able to participate in boys basketball camp and has adequate health insurance coverage. I hereby authorize the directors of the camp to act according to their best judgment in any emergency requiring medical attention. Insurance Agreement * I have read, understand, and agree to the above. Assumption of Risk and Release of Liability Parent/guardian First Name * Parent/guardian Last Name * Parent/guardian Email Parent/guardian Cell * THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS – READ IT CAREFULLY I have applied to participate in the Lawrence University program described as the 2017 Spring Clinics (“Program”) during the period June 13-16, 2017. I acknowledge that the Program is voluntary and may involve certain risks, including those described below. I understand that by participating in the Program, I will engage in: strenuous physical activity with other participants, competition, recreational activities and, if applicable, reside in student dormitories and travel off campus. I acknowledge that these activities present certain inherent risks that are beyond Lawrence University’s control. I choose to participate in the Program understanding its associated risks, and knowingly and voluntarily assume all risks of collision, injury, illness, death or damage to or loss of my property that may occur while engaging in sports, recreation and any other activities arising out of or related to the Program. I understand that I may discontinue participation at any time in light of the risks. I hereby forever release Lawrence University, its trustees, officers, employees, and agents (the “Released Parties”), from liability for any negligent act or omission arising from my participation in the Program, including related costs, damages, claims or assertions to which I or my family, estate, or heirs may claim against the Released Parties. This Assumption of Risk and Release of Liability shall be construed in accordance with the laws of the State of Wisconsin, which shall be the forum for any lawsuits filed under or incident to this Release or the Program. Liability Agreement * I have read, understand, and agree to the above. Photo Agreement I/we grant permission for photos/images of minor to be published in future Lawrence University Soccer Camp brochures, website or advertisements. CAPTCHA This question is included to prevent automated spam submissions; it is not presented to logged-in users. Continue to Payment
