Severn Boys Lacrosse Day Camp 2025

2025 Severn Boys Lacrosse Day Camp

June 16 - June 19, 2025 | Barbour Family Stadium | Severn School
Camper First and Last Name*

First NameLast Name
Camper DOB:*

MonthDayYear
Date
Camper Current Age:*
Camper Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Camper Currently Attends:*
Grade Entering Fall '25:*
Position:*

AttackMidfieldLSMDefenseGoalieFace Off
Campers Jersey Size:*

Small/MediumLarge/X Large
Current Lacrosse Team:*
Coaches First and Last Name:*

First NameLast Name
Coaches Email Address:*
example@example.com
Parent/Guardian #1 First and Last Name:*

First NameLast Name
Parent/Guardian #1 Phone Number:*
Please enter a valid phone number.
Parent/Guardian #1 Email Address:*
example@example.com
Parent/Guardian #2 First and Last Name:

First NameLast Name
Parent/Guardian #2 Phone Number:
Please enter a valid phone number.
Parent/Guardian #2 Email Address:
example@example.com
Medical Information:
Physicians First and Last Name:*

First NameLast Name
Physicians Phone #:*
Please enter a valid phone number.
Is your child currently on any medications?*

YesNo
Please list any allergies below:
EpiPen use?*

YesNo
Do any of these conditions require special attention? If YES, please explain further:
Liability/Waiver
*The undersigned, being a parent or legal guardian of this camper understands and accepts that injury is possible while participating in the sport of lacrosse. I knowingly assume all risks associated with my child’s participation, even if arising from negligence of the participants or others, and assume FULL responsibility for my child’s participation.

*I authorize the sport camp staff to secure the proper medical care as necessary to insure my child’s wellbeing.

*I certify that within the past 12 months my child has had a physical exam by a physician or NP and that he/she is physically able to participate in the sports camp activities.

*I hereby acknowledge that I am responsible for medical charges incurred during sports camp participation. I further understand that the sports camp carries an excess medical insurance policy for sports injuries to the camper that may result from camper activities. This policy may only be utilized after my primary insurance company has processed the claims and issued an explanation of benefits.

*I also give permission for the camp directors to take pictures of the camper to use for further promotions of Severn Boys’ Lacrosse camps and clinics.

My signature below indicates that I have read and understand these terms:
Parent/Guardian First and Last Name:*

First NameLast Name
Date:*

MonthDayYear
Date
Signature*

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Relationship to Camper:*
Contact Information
For further questions, contact Keegan Wilkinson at (301)526-5953 or reach out via email to k.wilkinson@severnschool.com. Please complete this form with payment to register for your spot!

My Products*

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Severn Boys Lacrosse Day CampIf registering multiple campers please fill out an individual regsitration for each camper to ensure we have all of their information. Thank you!

$275.00 Quantity

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2025 Severn Boys Lacrosse Day Camp

Medical Information:

Liability/Waiver

Contact Information