Lacrosse Academy
Registration
Please submit the following preliminary registration form online.
Click
here
to download the medical forms.
To secure your registration, please send in the completed medical paperwork along with
payment in full before June 15, 2008.
(
*
required field)
CAMPER information
*
Camper name:
(First Name)
(Last Name)
*
Preferred name:
*
Grade entering:
Fall 2008
Pre-K
Kindergarten
Grade 01
Grade 02
Grade 03
Grade 04
Grade 05
Grade 06
Grade 07
Grade 08
Grade 09
Grade 10
Grade 11
Grade 12
(Nickname, if applicable, or "none")
*
Date of birth:
(mm/dd/yy)
*
Home mailing address:
(Street)
(City/Town)
(State) (Zip)
*
Home telephone:
E-mail address:
Parent information
Mother
Father
*
First name:
*
Last name:
*
Home phone:
Work phone:
Cell phone:
