Registration Form • Please COMPLETE and Return with Payment
T-shirt Size (circle one): Youth S Youth M Youth L Adult S Adult M Adult L
Camper’s Name______________________________________ Birthdate__________ Grade Next Fall_______ Address_________________________________________ City & ZIP_______________________________ Preferred Phone #____________________________ Preferred Email________________________________ School Attended Last Year__________________________________________________________________ Relative to Contact in Case of EMERGENCY_______________________________________
Relationship ________________________________________ Phone_________________
Camp Fees
$50 for Campers Registered ON or BEFORE July 5, 2019 ($60 thereafter) • $5 DISCOUNT for each addt’l sibling Total Enclosed ____________ • Make Checks Payable to WKHS Girls Lacrosse Boosters and Mail to: WKHS, 1499 Hard Rd., Columbus, OH 43235, ATTN: Doug Troutner (or drop off during school hours)
Campers need to bring stick, mouth guard, goggles, and a water bottle (limited # of loaner sticks & goggles available)
The undersigned, as parent or guardian of the child named herein, desires that my child participate in the WKHS Wolves Girls Lacrosse Camp. By execution of this release I agree that all requirements, directions and standards set by the coaching staff and personnel, use of any equipment under the supervision of the coaching staff and personnel shall be deemed to have been accomplished for the benefit of my child. In consideration of the efforts on my child’s behalf, I do hereby voluntarily assume all risk of accident, injury, damage, and/or loss to my child or my child’s property which may arise out of my child’s participation in the camp, hereby intending to release and discharge Worthington City Schools, the Director, and all personnel associated or connected with the camp for every claim, liability, or damage of any kind caused by the negligence of Worthington City Schools, the camp directors, personnel involved or otherwise which may result from participation in the camp.
AUTHORIZATION: I authorize and request Worthington City Schools and camp personnel to refer my child to other duly licensed medical personnel for neces- sary emergency treatment when indicated, including transfer to outside hospitals.
Signature of Parent or Guardian & Date ____________________________________________________________________________________
