Leader Lacrosse, Inc.

 

Camper Registration & Payment

                           IMPORTANT!
Some Windows Vista systems, and school and corporate 
Internet systems, do not work well with the online form
submission process below.  If you have trouble with the 
forms below, please download the Registration, and
Health forms, and email them to us.  Then complete
the process by going to the 'Payments' page for online
payment by credit or debit card.  If you are mailing a
check, please advise in your email.

     
For online forms submission, you must complete
ALL STEPS in the registration and payment process. 
Read instructions carefully.

ON-LINE
Step 1. Please fill in Registration Form AND Health Form below.
Step 2. When you click 'submit' on the Registration Form,
you will come back to this page to the Health Form below.
Step 3.  When you click 'submit' on the Health Form, you
will be sent to the Shopping Cart for payment.  You can
pay through our Secure Shopping Cart's PayPal system
with Visa, Mastercard, Amex, DiscoverCard, or with a
PayPal account.

MAIL-IN PAYMENT
Fill out the Registration Form below, and then the Health
Form further below, which will be sent to us electronically.

Make checks payable to Leader Lacrosse, Inc.
Mail to:
Leader Lacrosse, Inc.
2098 Freywood Dr.
Marietta GA 30067

You will receive email confirmation of registration.


Cancellation Policy: A $100 administration fee will be
retained even if you cancel.  After May 15, 2008, refunds
(less the administration fee) will be given only for medical
reasons, when accompanied by a letter from a physician.
Refunds will not be mailed until August 1, 2008.  If a
camper is injured and must leave camp early, the refund
will be prorated for days missed only.

GROUP RATE:
As of April 15, 2008 the following groups are eligible for the
group rate.   If you do not see your group name, please contact
us by filling out the Contact Us form on the 'Contact Us' page.
You must commit to 10 or more players to qualify.

Lassiter High School (and its junior programs)
Walton High School (and its junior programs)
Pope High School (and its junior programs)
Kell High School (and its junior programs)
Westminster School (and its junior programs)


REGISTRATION FORM:

Name:

Address:

City:

State:

Zip:

Phone:

Email:

Birthdate mm/dd/yr:

Grade Fall 2008:

Male or Female

Position:

Prior Experience/years:

School:

Parent or Guardian:

Email:

Emergency Contact:

Phone:

Division I (Ages 16-18)
ENTER -  I:

Division II (Ages 13-15)
ENTER -  II:

Division III (Ages 10-13) 
ENTER - III:

Division IV (Ages 8-10)
ENTER - IV

Day Camper
ENTER $395.00:

Day Camper
Group Rate (10 or more)
ENTER $355.00:

Name of Group:

Total:

     

                 

Health Form

On-Line:  Fill in form below and click 'submit'
Mail-In:  Fill out this form and click 'submit'
and it will be transmitted electronically to us.

Campers will be covered under a group liability
policy for the camp. There will be a medical
trainer on site at all times, and emergency.
care will be summoned if required. If a camper
requires further medical treatment, he will be
transported to an appropriate medical facility.
There are doctors and hospitals minutes away
from both the fields and the school. Every
effort is made to protect the health and safety
of the campers.

No payment for medical services is agreed
or implied by Leader Lacrosse, Inc. , by Syracuse
University, or by any host High School.

IMMUNIZATION HISTORY Please insert dates

Hepatitis B:

TB Test:

Rubella:

Rubella Booster:

Chicken Pox:

Meningitis:

Tetanus:

Measles:

DTP Series:

Physician's Clearance:

Fracture in the last 6 mos.:

Surgery in the past year:

Seizure disorder:

Spinal or head injury:

Diabetes:

Hemophilia:

Loss of organ:

Heart Condition:

Hospitalization last 6 mos.:

Parent/Guardian Authorization:

Camper:

Parent/Guardian:

Witness:

Upon submittal of Health Form, you will be sent to
 the Shopping Cart for payment for Camper
2007 Copyright Leader Lacrosse, Inc.
All rights reserved.


You are Visotor Number