Please use your browser window to print, COMPLETE form and return with payment to:
WKHS Girls Lacrosse
ATTN: Doug Troutner
1499 Hard Rd.
Columbus, OH 43235
(or drop off during school hours)
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T-shirt Size (circle one): Youth S Youth M Youth L Adult S Adult M Adult L
Camper’s Name______________________________________ Birthdate__________ Grade Next Fall_____
Address_________________________________________ City & ZIP______________________________
Preferred Phone #____________________________ Preferred Email________________________________
School Attended Last Year__________________________________________________________________
Relative to Contact in Case of EMERGENCY_______________________________________
Relationship ________________________________________ Phone____________________
Camp Fees
$50 for Campers Registered ON or BEFORE June 9, 2017 ($60 thereafter) • $5 DISCOUNT for each addt’l sibling
Total Enclosed ____________ • Make Checks Payable to WKHS Girls Lacrosse Boosters and Mail to: WKHS, 1499 Hard Rd., Columbus, OH 43235, ATTN: Doug Troutner (or drop off during school hours)
Campers need to bring stick, mouth guard, goggles, and a water bottle (limited # of loaner sticks & goggles available)
The undersigned, as parent or guardian of the child named herein, desires that my child participate in the WKHS Wolves Girls Lacrosse Camp. By execution of this release I agree that all requirements, directions and standards set by the coaching sta and personnel, use of any equipment under the supervision of the coaching sta and personnel shall be deemed to have been accomplished for the bene t of my child. In consideration of the e orts on my child’s behalf, I do hereby voluntarily assume all risk of accident, injury, damage, and/or loss to my child or my child’s property which may arise out of my child’s participation in the camp, hereby intending to release and discharge Worthington City Schools, the Director, and all personnel associated or connected with the camp for every claim, liability, or damage of any kind caused by the negligence of Worthington City Schools, the camp directors, personnel involved or otherwise which may result from participation in the camp.
AUTHORIZATION: I authorize and request Worthington City Schools and camp personnel to refer my child to other duly licensed medical personnel for neces- sary emergency treatment when indicated, including transfer to outside hospitals.
Signature of Parent or Guardian & Date ____________________________________________________________________________________