INSTRUCTIONS:    PRINT FORM - FILL OUT - SEND TO ADDRESS AT BOTTOM WITH PAYMENT.  THANKS!

NAME (PLEASE PRINT)_________________________________________________________
ADDRESS____________________________________________________________________
CITY_____________________________________ STATE____ ZIPCODE____________
PHONE # (____)_________________ EMAIL________________________(required for confirm, please write clearly)

AGE_____ DOB______/______/______ Grade (as of Sept 2007)______  HEIGHT______ WEIGHT____

POSITION:     ATTACK    MIDFIELD    DEFENSE    GOALIE    YEARS PLAYED______

BOYS JERSEY SIZES (PLEASE CIRCLE ONE)  SMALL    MEDIUM   LARGE   X-LARGE

                                                               $75 OFF FIRST FIFTY CAMPERS TO SIGN UP!!!!!

                                                                    *Must be payment in full* 

Team Discount/minimum of 3 ($25)

PAYMENT ENCLOSED:______ $150 deposit_______________Payment in Full

WAIVER RELEASE: My son is in good health and has my full permission to participate in a vigorous lacrosse program. He has no previous sickness, illness, disease or bodily injury that is contradictory to participation. I fully understand that lacrosse is a contact sport and that physical injury may occur during the course of practice and games. In the event that cannot be reached I give my full permission for such medical procedures as may be deemed necessary by an examining physician. I also understand that FINNCROSSEE, is not responsible for the loss of any personal items.

PARENT / GUARDIAN SIGNATURE_______________________ DATE_____________________

HEALTH INSURANCE___________________________ POLICY#____________________

PAYMENT, and REFUND POLICY:
Payment will reserve you a space at "FINNCROSSE" this summer. Full refunds available three weeks prior to first day of camp. In event of a health related emergency or other family matters, credit can be given towards a future FINNCROSSE clinic or camp.

We will accept a check or money order, made payable to:  

Kevin Finneran
P.O. Box 40281
Philadelphia, PA 19106
(215) 292-4961

PAYMENT ENCLOSED $___________________________

*Confirm E-Mail will be sent with info and directions