Stone Harbor ExitZero Application

Please choose the camp(s) you want to attend. One application per person.

Choose Camp *

June 29 - July 3, 2020 $ 150.00

July 6 - July 10, 2020 $ 150.00

July 13 - July 17, 2020 $ 150.00

Total $ 0.00

Participant Name: *

First Name Last Name

Birthdate *

Date

Describe your experience in the sport of lacrosse. *

None Some One-two years 2+ years

Shirt Size (childrens) *

S M L XL

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Participant Cell Phone Number *

Area Code Phone Number

Parent/Guardian Name *

First Name Last Name

Parent/Guardian E-mail *

Parent/Guardian Phone Number *

Area Code Phone Number

Health Insurance Provider *

Emergency Contact *

First Name Last Name

Emergency Contact Phone Number *

Area Code Phone Number

No refunds after May 15, 2020

Waiver of Liability:

In signing this application, I release ExitZero, the girl's lacrosse camp, and other involved parties from any claims or responsibility for injuries suffered in the tournament. I knowingly assume all risks associated with participation, even arising from the negligence of the participants or others and assume full responsibility for my participation. I certify that I am in good physical condition and can participate in the ExitZero Girls Lacrosse Camp. Further, I authorize the site director to request medical treatment as necessary to ensure my well-being.

Signature *

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Girls (Ages 8-12) Lacrosse Camp - Stone Harbor NJ