2015 Dorman Lacrosse Summer Camp
Camp is June 15-18, 2015 at Dorman High School Lower Fields (8:30am-11:30am)
Pre-registration cost is $60.00 (Before May 22nd, 2015) After May 22, Registration is $70.00 (including on day of camp)
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Camp is open to rising 2nd graders through rising 10th graders who were not part of the Varsity program
Loaner equipment will be made available for use during the camp.
What to bring: Campers should bring stick, helmet, gloves, and dress comfortably in shirt/shorts and wear cleats. Tennis shoes may be brought for
weather causing us to go indoors.
Camper Name: ______________________________________________________
T-Shirt Size (circle one):
YS
YM
YL AS
AM
AL
AXL
A2X
A3X
Grade in 2015-2016: _________
Loaner Equipment Required (circle one):
Yes No
Parent/Guardian Contact Information:
Name: ____________________________________________Phone (Best number to reach you):_______________________
Address: _______________________________________________________________________________________
Street, City, Zip Code
Alternate Contact/Phone___________________________________________________________________________
MEDICAL/ALLERGY INFORMATION
My child has allergies to the following: _______________________________________________________________________
_____My child has exercise induced asthma. Please watch his/her breathing
_____My child is allergic to Bee Stings and carries an Epi-pen
_____My child does NOT have asthma or other allergies that require medical attention, nor any other serious known medical issues that camp
staff should be made aware of to ensure safety and proper treatment if a problem were to arise.
If a reaction requires emergency treatment, he:
_____ carries emergency medicine and can administer his medication _____ needs assistance administering the medication (Leave w/ trainer)
Any other pertinent information in regard to any medical or health issues:
_________________________________________________________________________________________________________________
EMERGENCY, MEDICAL, AND PUBLIC RELATIONS RELEASE
I hereby authorize the Directors of the Dorman Lacrosse Camp to act for me according to their best judgment in any emergency requiring medical attention. I
know of no medical or physical condition which affects my child’s ability to safely participate in this camp. I understand that I will be fully responsible for any
injury that may occur at this camp. During the course of the camp, camp staff, newspaper, television, or other media may take photographs of campers. These
photos will be used on television, print, or social media outlets. In addition, names may be released to newspaper or television media if requested. By signing
below, you give your permission for your child to participate in every portion of the camp as well as in any and all of these public relations activities.
_____________________________________________________
Parent or Guardian Signature
________________________________
Date:
PLEASE NOTE: All campers are expected to show respect for coaches and fellow campers. If at any time a camper does not follow
camp rules, he may be excused for the remainder of camp by the Camp Director or his designee, and no refund will be given. Campers
are expected to model sportsmanship, courtesy, respect, and proper manners throughout the camp. Our goal is for all Cavaliers to be
model citizens and to represent themselves, their families, and our school in a first class manner! GO CAVALIERS!
Please make checks payable to: Dorman High School Lacrosse Camp
Mail registration form to:
Dorman Lacrosse Camp
c/o Coach Neuder
1050 Cavalier Way
Roebuck, S.C. 29376
Please call Coach Joel Neuder at (864) 208-6470 or e-mail at [email protected] with any questions