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LONG ISLAND'S ELITE CAMPS and TOURNAMENTS
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 Meet our Coaches
Shannon Smith Torin Varn Amanda Johansen
 

Registration Form

Please fill out this form

* First Name:
* Last Name:
* Email:
* Phone Number:
* Address1:
* City:
* State:
* Zip:
* Select a Tournament:
* Team Name:
* Graduation Year:
* Jersey Number:
* Position:
* Committed:
if committed, School Name:
Consent / Waiver

* Yes, I accept the waiver and consent to participate

* Name of Person Completing This Event Consent/Waiver Form

* US Lacrosse #

INSURANCE INFORMATION

All participants are required to be covered with insurance for accidental injury. In most instances, family health insurance is adequate. Please indicate your family health insurance plan below.

* Health Insurance Company:

* Policy #:

FOR ANY PARTICIPANT WHO IS NOT YET 18 YEARS OLD

As parent or legal guardian of this participant, I hereby verify my signature below that I have read and fully understand each of the conditions under the Participant Waiver & Release section for permitting my child to participate in any lacroSSe by 3 INC. sponsored events and activities, and I accept each of the conditions, especially the waiver and release set forth above.

I/We being the legal guardian of the applicant, authorize the lacroSSe by 3 INC. and its agents permission to request treatment as necessary to sure the well being of our dependent.

* Signature of Parent/Guardian: