Lady Golden Eagles Lacrosse Youth Camp
Girls Entering Grades K-8 MONDAY, 6/22/19 to THURSDAY, 6/25/19 (9:00 am - 1:00 pm)
Shirt Size (YS, YM, YL, AS, AM, AL)
# of Years Played
Suite or Apt. #
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Parent/Guardian Last Name:
Parent/Guardian First Name:
Parent/Guardian Cell Phone #:
Parent/Guardian Home Phone #:
Waiver - Release of Liability
I am aware that Lacrosse is an aggressive, physical sport involving severe cardiovascular stress and violent physical contact. I understand that Lacrosse involves certain risks, including but not limited to death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles, and internal organs. I am also aware that equipment used for my protection may be inadequate to prevent serious injury. In addition, I understand that participation in Lacrosse involves activities incidental thereto, including but not limited to travel to and from the site of the activity, participation at sites that may be remote from available medical assistance, and the possible reckless conduct of other participants. I am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death.
Also, in consideration of my participation in Scuderi Sports Camps & Clinics, LLC, I hereby release, hold harmless and covenant not to sue Scuderi Sports Camps & Clinics, LLC, its representatives, its venue providers, and any of its sponsors, lessors, volunteers, referees, employees, instructors, coaches or agents (hereinafter collectively “Scuderi Sports Camps & Clinics, LLC”), from any and all present and future claims for property damage, personal injury, or wrongful death arising as a result of my participation in the Camp and associated activities, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all such claims, both present and future, that may be made by me, my family, estate, heirs, or assigns. I further agree to defend and indemnify Scuderi Sports Camps & Clinics, LLC should any claims be asserted against Scuderi Sports Camps & Clinics, LLC by third parties because of my claims for property damage, personal injury, or wrongful death.
I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of the State of New Jersey and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further affirm that the venue for any legal proceedings shall be in the State of New Jersey. I affirm that I am of legal age, or that as a minor I am having a legally recognized parent or guardian execute and I/we are freely signing this agreement. I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies which may be available to me for claims against Scuderi Sports Camps & Clinics, LLC or any of the parties listed above.
Terms and Conditions Acceptance
I/We Hereby Accept the Terms and Conditions above.
**Note: Medical emergencies will be referred to the local medical center.
Emergency Contact Name:
Emergency Contact Primary Phone Number:
Emergency Contact 2 Name:
Emergency Contact 2 Primary Phone Number:
Does the participant have any allergies, present medication, special considerations, etc.:
If Yes, Please Explain:
PAYMENT - $100 per player (The fee for the four days is nonrefundable and will include instruction, all activities, and t-shirt - if registered by 6/1.)
Payment Options: Check - Made out to "Scuderi Sports Camps & Clinics, LLC" can be sent to 1208 West High Street, Haddon Heights, NJ 08035
The camp will be held at Seneca High School in Tabernacle, NJ. The sessions will run for four consecutive days, Monday, June 22nd to Wednesday, June 25th from 9:00 am - 1:00 pm. Campers should be dropped off by 8:45 am and picked up by 1:15 pm. All campers must provide their own equipment (stick, goggles, mouth guard, cleats/sneakers), water bottle/water and snack.
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