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Beginners Day Camp
Camp Director: Offensive Coordinator, Rick Kladis

To register for any camp sessions, please complete this short registration form. As long as you can check a session, there is still space available!

Players Information:
Athlete First Name: Athlete Last Name:
Athlete Phone:
Age: (as of 7/1/2012)
Position:
Parent/Guardian Information:
Parent First Name: Parent Last Name:
Email Address:
Address:
City: State: Zip:
Parent Phone:
Insurance Information:
Insurance Carrier: Policy Number:

I (We) the undersigned, hereby certify that I (we) are the parent and/or guardian of the participant and hereby give permission to the University of Utah Lacrosse Camp staff to seek appropriate medical attention as necessary to insure the wellbeing of my (our) child.

Additionally, I (We) the undersigned, for ourselves, our heirs, executors, and administrators, waive, release and forever discharge Utah Lacrosse, it's staff, officers, agents, employees, representatives, successors, and assign of and from all rights and claims for damages, injuries, or loss of person or property, which may be sustained or occur during participation of a Utah Lacrosse Event and it's activities, whether or not damages, injury, or loss is due to negligence.

By entering your name below, you agree to the above statements:
Parent/Guardian Signature: Date Signed:
Camp Session Information:
Please select the session(s) you would like to register for:
Session 1: July 6th, 2012
Session 2: July 13th, 2012
Any medical issues that we could be aware of?
After completing the above form, please click "Submit." You will then be taken to a link to submit your payment for the session(s) you selected.