Musketeer Lacrosse Camp 2018
Summer 2018

July 9th-12th*
9 AM- 3 PM
Grades 1-9

BEN FRANKLIN MIDDLE SCHOOL
335 North Van Dien Ave.
Ridgewood, NJ 07450

*Rain Date 7/13 if needed

Email address *
Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Grade as of September 2018 *
Your answer
Address (Street, Town, State, Zip) *
Your answer
US LACROSSE NUMBER
Your answer
PARENT E-mail #1 *
Your answer
PARENT E-mail #2 (optional)
Your answer
Parent #1 Cell Phone Number *
Your answer
PAYMENT INFORMATION
PAYMENT INFORMATION - Refunds only issued when a Dr. note is presented.

Musketeer Lacrosse Camp Fee:
If RECEIVED by 6/15/18: $275.00
If RECEIVED AFTER 6/15/18: $300.00

PAYMENT OPTIONS: Check OR Venmo *
Required
MUSKETEER LACROSSE PARTICIPANT WAIVER
MUSKETEER LACROSSE Participant Waiver and Release of Liability Form Agreement: In consideration of my membership in US Lacrosse and of my participation of the sponsored activities of the Musketeer Lacrosse LLC, I acknowledge to and understand that:

1. READINESS TO COMPETE: Voluntarily and my own free will I elect to participate as a member of the Musketeer Lacrosse LLC. I will only participate in those US Lacrosse competitions and activities sponsored by the Musketeer Lacrosse LLC for which I am physically and psychologically prepared to compete.

2. MEDICAL ATTENTION: I hereby give my consent to the US Lacrosse association and to the Musketeer Lacrosse LLC and the host organization of any US Lacrosse sponsored event to provide, through a medical staff of its choice, customary medical/athletic training transportation and emergency medical services as warranted through the course of my participation in sponsored lacrosse activities.

WAIVER AND RELEASE OF LIABILITY: I am fully aware of and appreciate the risks associated with the participation in a lacrosse event, including the risk of catastrophic injury, paralysis and even death, as well as other types of damages and loss. I further agree on behalf of myself, my heirs, and personal representatives, that the US Lacrosse association , the Musketeer Lacrosse LLC, the host organization, and the sponsors of any US Lacrosse Event, along with their coaches, volunteers, employees, agents, officers, and directors of these organizations shall not be liable for any injury, loss of life or other loss or damage occurring as a result of participation in these event(s).

A PARENT NAME WILL SERVE AS AN ELECTRONIC SIGNATURE ACKNOWLEDGING YOU READ AND UNDERSTAND THE PARTICIPANT WAIVER AND RELEASE OF LIABILITY FORM AGREEMENT. *
Your answer
Emergency Contact (other than parent) Name *
Your answer
Emergency Contact Cell Phone Number *
Your answer
Please email christie@musketeerlacrosse.com with any registration questions.
A copy of your responses will be emailed to the address you provided.
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