South River High School Girl's Lacrosse Camp

Learn from the South River Coaches and 2014 Varsity Lacrosse Players!
Date: July 14-17 Time: 8 am - 11 am
Cost: $125 - Please make your checks out to “South River Girls Lacrosse” and send
to David Klingel: 201 Central AVE, East Edgewater, MD 21037 by July 8th.
Ages: 6 – 13
Levels: Beginner – Advanced (girls will be grouped by age and experience). We have loaner equipment for beginners.
Location: South River High School on the Bermuda fields located behind the school. Address: 201 Central AVE, East Edgewater, MD 21037.
Registration: Send emergency form in with your check. Please plan to arrive between 7:30 am – 7:45 am on Monday, July 14th.
Questions: samfarrell15@aol.com
Girl’s Lacrosse Emergency Contact Form
Player Information: Grade ________________________________
Name_________________________________________________________ Experience ___________________________
Home Address________________________________________________________________________________________
Home Phone__________________________________________________________________________________________
Email__________________________________________________________________________________________________Person to Contact in case of Emergency:
Name______________________________Phone________________________Relation___________________________
Name______________________________Phone________________________Relation___________________________
Primary Care Physician:
Name________________________________________________Phone___________________________________________
Please list any medical conditions, medications, or allergies we should be aware of
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Parent/Guardian Statement: I understand and accept that there are risks of serious injury and death in any sport. I hereby give permission for my child to participate in this activity. I hereby authorize medical treatment and/or transportation to a medical facility for any injury illness deemed urgently necessary by a licensed trainer, coach, or medical practitioner. In case of injury, I do not hold South River High School, its coaches and players, or the Anne Arundel County School District responsible.
Signed: ______________________________________________________ Date: ___________________________
Parent/Guardian
Youth Sizes Adult Sizes
T-shirt Size (circle): YS YM YL S M L XL
Loaner Equipment Needed (circle): Stick Goggles