Summer Camp

Summer Camps 2018

Registration Form for the 2018 High Impact Lacrosse Summer Camps

PLAYER INFORMATION
Name*
First Last
Gender*
Date of Birth*
Date Format: MM slash DD slash YYYY
Grade to be (Fall '18)*
Position
Years Played*
School and/or Youth Program*
US Lacrosse Number & Exp. Date*
PARENT/GUARDIAN INFORMATION
Name*
First Last
Email*
Enter Email Confirm Email
2nd Email
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Secondary Phone
Emergency Contact Number*
WAIVER RELEASE: My child is in good health and has my full permission to participate in a vigorous lacrosse program. My child has no previous sickness, illness, disease or bodily injury that is contradictory to participation. I fully understand that lacrosse is a contact sport and that physical injury may occur during the course of practice and games. In the event that I cannot be reached I give my full permission for such medical procedures as may be deemed necessary by an examining physician. I also understand that Hi-Impact Lacrosse, Inc. is not responsible for the loss of any personal items and all registrations are NON-Refundable unless a medical emergency in which a signed doctors note is required.*
- I agree
Camp Info
Select your desired camp*
- Aliso Niguel HS June 5th-8th
- BYLA Camp June 25th-27th
- New Rochelle Camp Aug. 20th-22nd
Payment Type*
- Check
- Credit Card (3% Convenience Fee)
Coupon

Sibling Discount
Convenience Fee*
Price: $0.00
Total
$0.00
CAPTCHA
Please make check payable to High Impact Lacrosse Inc.

Mail To:
High Impact Lacrosse Inc.
P.O. Box 1214
Yonkers, NY 10703
Billing Info
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Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Summer Camp

Summer Camps 2018

PLAYER INFORMATION

PARENT/GUARDIAN INFORMATION

Camp Info

Billing Info

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