Registration and Emergency Form

Lazer Lax Registration

After completing this form you will be brought to a payment page. Select the number of athletes who you have attending and it will redirect you to paypal. If you would prefer to pay by check, mail the check along with your son's name and age to: Lazer Lax Lacrosse 9 6th St Melrose Ma, 02176

Athlete Name or Names - Place on same line if multiple*
First Last
T Shirt Size*
Address*
Street Address City State ZIP Code
Parent/ Guardian Name*
First Last
Parent/Guardian Phone Number*
Email*
Emergency Contact*
First Last Relationship
Emergency Contact Phone Number*
Physician Name*
Name Phone Number
Insurance*
Insurance Company Policy Number
Does your child have any allergies, have any physical issues, or take any medication we should be aware of?
Release Statement*
I agree to the privacy policy.
I, the parent/guardian of the above named camper, give permission for my child to receive emergency medical treatment and hospitalization, if necessary. I understand that every attempt will be made to contact me, or the named alternate contact above, before taking this action. By enrolling my child, I ensure that he is physically and mentally able to participate in all of the programs activities. I hereby waive and release Lazer Lax Lacrosse – its directors and staff from any liability for any injury or illness incurred while attending camp. I understand that there is a risk of injury to my child as a result of camp activities, and knowingly and voluntarily assume all risk of such injury. I will be financially responsible for any medical attention needed during camp or resulting from an injury received at camp. My medical insurance shall be the insurance coverage for any medical treatment.