CAMP INFORMATION

Men's Lacrosse Fall Ball 2024

Open to Boys in grades 9-12

At CCA on blacktop, weight room and grass fields

Tuesdays and Thursdays

4 pm to 5:30 pm

$100 per person/session

Session 1: 9-3-24 to 9-26-24

Session 2: 10-1-24 to 10-31-24

Session 3: 11-5-24 to 12-12-24

Session 4: 1-9-25 to 2-6-25

PARTICIPANT INFORMATION

How many participants are you registering? (max 5) *

First Name *

Last Name *

Birth Date * 🛈 +

Grade This Fall *

School enrolled in. *

Choose your session(s) *

Session 1: 9-3-24 to 9-31-24

Session 2: 10-1-24 to 10-31-24

Session 3: 11-5-24 to 12-12-24

Session 4: 1-9-25 to 2-6-25

First Name - 2 *

Last Name - 2 *

Birth Date - 2 * 🛈 +

Grade This Fall - 2 *

School enrolled in-2 *

Choose your session(s)-2 *

Session 1: 9-3-24 to 9-31-24

Session 2: 10-1-24 to 10-31-24

Session 3: 11-5-24 to 12-12-24

Session 4: 1-9-25 to 2-6-25

First Name - 3 *

Last Name - 3 *

Birth Date - 3 * 🛈 +

Grade This Fall - 3 *

School enrolled in-3 *

Choose your session(s)-3 *

Session 1: 9-3-24 to 9-31-24

Session 2: 10-1-24 to 10-31-24

Session 3: 11-5-24 to 12-12-24

Session 4: 1-9-25 to 2-6-25

First Name - 4 *

Last Name - 4 *

Birth Date - 4 * 🛈 +

Grade This Fall - 4 *

School enrolled in-4 *

Choose your session(s)-4 *

Session 1: 9-3-24 to 9-31-24

Session 2: 10-1-24 to 10-31-24

Session 3: 11-5-24 to 12-12-24

Session 4: 1-9-25 to 2-6-25

First Name - 5 *

Last Name - 5 *

Birth Date - 5 * 🛈 +

Grade This Fall - 5 *

School enrolled in-5 *

Choose your session(s)-5 *

Session 1: 9-3-24 to 9-31-24

Session 2: 10-1-24 to 10-31-24

Session 3: 11-5-24 to 12-12-24

Session 4: 1-9-25 to 2-6-25

Current Total:

$0.00

Parent / Legal Guardian Information

Relationship to Participant(s): *

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone *

2nd Phone *

Email Address *

Health Insurance Information

Participant First Name *

List any physical or emotional limitations your child/participant may have: *

Participant First Name - 2 *

List any physical or emotional limitations your child/participant may have: *

Participant First Name - 3 *

List any physical or emotional limitations your child/participant may have: *

Participant First Name - 4 *

List any physical or emotional limitations your child/participant may have: *

Participant First Name - 5 *

List any physical or emotional limitations your child/participant may have: *

By checking this box, I confirm that the participant(s) is/are covered by Health Insurance. Participant(s) must have Health Insurance to participate in this camp. Please provide Health Insurance information below. *

I confirm that the participant(s) is/are covered by Health Insurance.

Health Insurance Carrier *

Policy Holder's Full Name *

Health Insurance Group Number *

Health Insurance ID Number *

Health Insurance Phone Number *

Waiver Information

READ THIS WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT FOR RISKS, INCLUDING BUT NOT LIMITED TO, COMMUNICABLE DISEASES (COVID-19)

By clicking on this form, you confirm that you have read and agree to all terms in the above Waiver, Release, Assumption of Risk and Indemnification Agreement for Risks, Including But Not Limited To, Communicable Diseases (COVID-19). *

I have read and agree to all terms in the Waiver, Release, Assumption of Risk and Indemnification Agreement for Risks, Including But Not Limited To, Communicable Diseases (COVID-19).

An email confirmation and payment receipt will be sent to the email address listed.

If you do not receive both of these emails, you have not successfully registered for the camp. Be sure to check your spam folder.

Please contact camp support at accounting@canyoncrestfoundation.org if you need assistance.