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Liverpool Girls' Lacrosse Summer Program

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					                     Liverpool Girls’ Lacrosse Summer Program
                                  Presented by the Town of Clay
                                  Camp Director: Elizabeth Acee
        Wayne Morris, Recreation Commissioner ~ Damian Ulatowski, Town Supervisor
Session 1: 8:00 AM – 9:30 AM
    -For girls entering grades 3 through 8

Session 2: 10:00 AM – 12:00 PM
    -For girls entering grades 9 through 12

When:
  -Week 1: June 28, 29 & 30: Tues, Wed, Thurs
  -Week 2: July 5, 6 & 7: Tues, Wed, Thurs
  -Week 3: July 12,13 &14: Tues, Wed, Thurs

Where: Liverpool High School
Cost: $75 per player
Included: Instruction, certified athletic trainer, camp pinny
Equipment: Please bring a stick, mouth guard, water bottle and athletic wear
Forms: Can also be found at townofclay.org
Checks Payable To: Town of Clay Girl’s Lacrosse Camp
Mail Application and Money To: Elizabeth Acee
                                      333 Forest Hill Dr.
                                      Syracuse, NY 13206
Questions: Please contact Elizabeth Acee: Eacee@Liverpool.k12.ny.us

  * T.O.C. sign ups will be held on May 1st from 6-7:30pm in the Liverpool High School gym*
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                                 REGISTRATION FORM
Participants Name ________________________________ D.O.B. ____________
Address ___________________________________________________________
Home Phone ______________ Work________________ Cell ________________
Grade in fall 2011 ___________ Age ____________ School __________________
T-shirt Size (circle one) YS YM YL AS AM AL AXL
Email Address: ______________________________________________________
Session Attending: _____________ Time ________________________________

      Town of Clay Recreation and Human Resource Youth Permission Waiver
         I understand participation in the Town of Clay Girls Lacrosse Summer Program involves rigorous
physical activity and risks of physical injury, and we assume these risks. I hereby accept responsibility for
emergency transportation and treatment in the event of illness or injury. I hereby accept responsibility for
the payment of any emergency transportation or treatment on behalf of the participant. I further certify the
participant is in good physical condition, and has no medical or physical conditions that would restrict
his/her participation in this event.
         (Parent/Guardian Signature) _______________________ on this date, 2011 does herby covenant
and agree to release and hold harmless the Town of Clay from and against any and all liability, loss,
damages, claims, or actions (including costs and attorney fees) for bodily injury and/or property damage, to
the extent permissible by law arising out of participation in (name of event) _______________________
during (dates) ______________________ 2011.
Pictures and other materials, which include my child, may be used for Town of Clay promotional purposes.
         There is no medical insurance carried by the Town of Clay for program participants.
         FULL REFUND GIVEN ONLY 48 HOURS IN ADVANCE OF PROGRAM START

Medical/Allergy History ________________________________________________________________

Additional Person/Phone # to contact in an Emergency ________________________________________

Check/Money Order # _____________ Cash Receipt # __________ Amt. Paid $___________________

				
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