2021 Winter Camp Registration Please enable JavaScript in your browser to complete this form.Athlete's First Name *Athlete's Last Name *Athlete's Cell Phone *Athlete's Email Address *Athlete's Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian First Name *Parent/Guardian Last Name *Parent/Guardian Email *Parent/Guardian Cell *Parent/Guardian Address (if different from yours)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you Wish to add a second Parent/Guardian Information?NoYesSecond Parent/Guardian First Name *Second Parent/Guardian Last Name *Second Parent/Guardian Email *Second Parent/Guardian Cell *Health Insurance Provider *Health Insurance Policy Number *US Lacrosse Number *If you don't know your US Lacrosse Number you can visit US Lacrosse Membership LookupDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School Name *Graduation Year *20212022202320242025Try Out Date *Arrange with CoachCamp Sessions Sunday, 12/5 2:00-4:00 Sunday, 12/12 2:00-4:00 Sunday, 12/19 2:00-4:00Cost Session 1 $25 Session 2 $25 Session 3 $25 All 3 sessions $60Submit