Lavday 2019 Registration
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2019 – LavenderDay Summer Girls & Boys Soccer Camp Registration Application (2019) – July 29th to August 2nd ,2019 Monday-Thursday – 9AM-3PM Friday 9AM-1PM
Ages 6 thru 15 15 Columbia Avenue Lynn, MA 01902 (781) 595-6763 – [email protected]
$275.00 per Camper-Full Day 195.00 – Half Day (9AM-NOON) NO DISCOUNTS OF ANY KIND
(Name) _______________________________(DOB)__________ (Name) _______________________________(DOB)__________ (Name)_______________________________(DOB)__________
Address: _____________________________________________________________________ Town/City/State/Zip_____________________________________________________________ Parent/Guardian Name: __________________________________________________________ Phone (Home/Work/Cell): _________________________________________________________ Email Address: _________________________________________________________________ Emergency Contact: _____________________________________________________________
Name/Phone of Physician: _________________________________________________________ TOTAL AMOUNT ENCLOSED: ______________________________
ALL PAYMENTS ARE FINAL!! REQUIRED SIGNATURE BELOW! In the event of illness or injury, I grant the LavenderDay Soccer Camp the right to take appropriate action for my child’s health and safety and to obtain any necessary medical assistance. I will be fully responsible for all medical expenses incurred by my child while attending the program. I, the undersigned for us, our heirs, executors and administrators waive, release, and forever discharge LavenderDay Soccer Camp and its staff and assign of and from all rights and claims for damages, injury or loss to person or property which may be sustained during participation in camp activities or while at camp. I understand that lost equipment and personal belongings are not the responsibility of the Camp. Campers unable to participate due to mild injury or illness, etc. will be treated by the on-site health supervisor. Parents/guardians or emergency contacts will be contacted for more serious illnesses or injuries. Campers needing hospitalization will be taken by ambulance.
________________________________________________________
Parent/Guardian Signature/Date
Ages 6 thru 15 15 Columbia Avenue Lynn, MA 01902 (781) 595-6763 – [email protected]
$275.00 per Camper-Full Day 195.00 – Half Day (9AM-NOON) NO DISCOUNTS OF ANY KIND
(Name) _______________________________(DOB)__________ (Name) _______________________________(DOB)__________ (Name)_______________________________(DOB)__________
Address: _____________________________________________________________________ Town/City/State/Zip_____________________________________________________________ Parent/Guardian Name: __________________________________________________________ Phone (Home/Work/Cell): _________________________________________________________ Email Address: _________________________________________________________________ Emergency Contact: _____________________________________________________________
Name/Phone of Physician: _________________________________________________________ TOTAL AMOUNT ENCLOSED: ______________________________
ALL PAYMENTS ARE FINAL!! REQUIRED SIGNATURE BELOW! In the event of illness or injury, I grant the LavenderDay Soccer Camp the right to take appropriate action for my child’s health and safety and to obtain any necessary medical assistance. I will be fully responsible for all medical expenses incurred by my child while attending the program. I, the undersigned for us, our heirs, executors and administrators waive, release, and forever discharge LavenderDay Soccer Camp and its staff and assign of and from all rights and claims for damages, injury or loss to person or property which may be sustained during participation in camp activities or while at camp. I understand that lost equipment and personal belongings are not the responsibility of the Camp. Campers unable to participate due to mild injury or illness, etc. will be treated by the on-site health supervisor. Parents/guardians or emergency contacts will be contacted for more serious illnesses or injuries. Campers needing hospitalization will be taken by ambulance.
________________________________________________________
Parent/Guardian Signature/Date
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