2009 Camp Session II Registration
Please fill out all the fields below.
* denotes required field

Players' Name*

Parent/Guardian Name*

Address*

City*

State/Province*

Zip Code/Postal Code*

Home Phone*

Business Phone*

Cell Phone

Players' Email*

Parent's Email*

Emergency Contact*

Emergency Contact Number*

Emergency Contact Relotionship*

Current Team

Age*

Current Grade

Field Position

Jersey Size*

Years Experience*

Comments

2009 Medical Form
Please fill out all the fields below.

Date of last tetanus immunization *

Pre-existing injury currently under treatment: * Yes No

If yes, please explain:

Mental disorders or convulsions: * Yes No

If yes, please explain:

Contact lenses or glasses: * Yes No

Medical conditions currently under treatment: * Yes No

If yes, please explain:

Allergies (to drugs, food asthma, etc.): * Yes No

If yes, please explain:

Please list medication(s) required to be taken

Carrier Name (OHIP):

Policy Number:

Policy Holder Name:

Policy Holder's Date of Birth

Your Insurance/OHIP policy information allows us to facilitate the admittance of your son/daughter for emergency medical treatment.

OHIP/Medicare # (Canada):

or

Carrier Name (US):

Policy Number

I hereby give permission for the True North Lacrosse, Inc. and True North Sports L.L.C., to be responsible for providing proper medical supervision and treatment of my son and/or daughter. For valuable consideration, including the acceptance of my child / ward as camper at the True North Lacrosse, Inc. and True North Sports L.L.C. I for myself and my child / ward covenant and agree that neither my child nor our respective heirs and legal representatives will ever institute any action or suit or institute, prosecute or in any way aid in the institution or prosecution of any claim, demand or cause of action for damages or compensation against the True North Lacrosse, Inc., and True North Sports L.L.C., the True North Lacrosse Camp, The Town of Orangeville, The Tony Rose Arena, The Upper Grand School Board, Dufferin County Board of Education, Princess Elizabeth School, Orangeville District Secondary School, Dufferin County, the Pennington School, the Town of Pennington, the City of Saint John or their respective officers, directors, employees and agents, counselors by reason of any damage loss or injury to person or property arising out of the departure of my child / ward from normally scheduled activities of the camp / clinic and that each of my child / ward and I and our respective heirs and legal representatives, jointly and severally, will indemnify and save harmless those entities and persons from liability, cost and expense whatsoever in connection with any such claims.

I understand True North Lacrosse retains the right to use for publicity and advertising purposes photographs of campers taken at camp.