STARS Lacrosse Club 2016-2017 Tryout Registration From

Player Information - STARS Summer Clinics 2019

First Name *

Last Name *

Grade for 2019-2020 School Year *

Birthdate *

Age as of 9/1/2019 *

School *

US Lacrosse # (required). Go to http://www.uslacrosse.org/membership to join. *

Registration

Please indicate which summer session your daughter would like to attend (players can attend both sessions): *

Session 1: July 8 - July 11 (Mon-Thurs)

Session 2: July 29 - August 1 (Mon-Thurs)

Family Information

First Name *

Last Name *

Relationship to Player *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address: please note this is the address we will use to notify you of any changes /updates before the camps and to keep you up-to-date on STARS Lacrosse Club. *

Primary Phone *

Alternate Phone

Family Insurance Information

Insurance Company *

Group # *

ID # *

Consent

I give my consent and approval for my daughter’s participation in the STARS Lacrosse Clinic at St. Stephen’s and St. Agnes School, Episcopal High School, local city fields and other practice and tournament field locations identified by the STARS Club and coaches. I / We hereby release and hold harmless the employees of STARS, it’s agents and employees, from all claims, damages or other liabilities for injuries to the player which are not the result of gross negligence by the STARS employees or the School, it’s agents or employees. I understand the School does not provide accident insurance. I hereby authorize any medical treatment which may be advised while my child is enrolled in the STARS Lacrosse clinic.

I agree to grant to STARS and its authorized representatives' permission to record on photographic film and/or video, pictures of my participation. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, or other printed materials used to promote STARS.

I HAVE READ AND AGREE TO THE ABOVE *

Yes

No

ADDITIONAL DETAILS AND PAYMENT INFORMATION

Time: 4-day Sessions (4:30 – 6:30pm), Monday - Thursday

Location: Episcopal HS (3900 West Braddock Road, Alexandria, VA)

Coaches: Kristin Burkhalter (Duke, STARS), Ashley McDowell (Brown, EHS Head Coach), Stacey Williams (OSU, Goucher, SSSAS) and many others.

Benefits: Focused sessions, Skills Training, Team Concepts, Prep for League Try-outs, Conditioning & Footwork, Goalie Training

Cost: $165 / 4 day session (MAIL CHECKS BEFORE JUNE 21 to the following address)

STARS Lacrosse

4108 N. Garland Street

Alexandria, VA 22304

Send payment now through PayPal to starslacrosse@yahoo.com.

One Week of Clinic ($165.00)

Two Weeks of Clinic ($330.00)

CONTACT INFO

Contact Informaion:

STARS Lacrosse Club / www.starslax.com /starslacrosse@yahoo.com / (202) 677-9222