LONG ISLAND SUMMER SHOWCASE CAMP

EXPLORE MORE AT

SURGEELITELAX.COM

MAIL TO:

128 POINTE CIRCLE SOUTH

CORAM, NY 11727

SURGEELITELAX@GMAIL.COM

KARA MUPO

AND

PRESENT

JULY 30TH

OPEN TO ANY AND ALL HIGH SCHOOL GIRLS GRADUATING IN 2018-2020

9AM-12PM 1PM-4PMBLUE (2020) VOLT (2018/2019)

FEATURING COACHES FROM: ARMY, COLUMBIA, MARQUETTE, MOUNT ST. MARY'S, OHIO STATE, STONY BROOK, UMASS, VANDERBILT, WAGNER AND WILLIAM & MARY

VENUE DETAILS:ST. JOSEPH'S COLLEGE

246 Service RoadPatchogue, NY 11772

2X NATIONAL

CHAMPION & CURRENT

TEAM USA MEMBER

SESSION: (CIRCLE ONE)

$155.00

NAME:

EMAIL:

EMERGENCY CONTACT:SURGE ELITE LACROSSE ACADEMY

EMERGENCY CONTACT PHONE:LIABILITY RELEASE: IN CONSIDERATION OF MY ATTENDANCE, I, THE UNDERSIGNED PARTICIPANT INTENDING TO BE LEGALLY BOUND, DO HEREBY FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS , WAIVE, RELEASE AND FOREVER DISCHARGE ANY AND ALL RIGHTS AND DAMAGES WHICH I OR ANY OF US MAY HEREAFTER HAVE AGAINST SURGE ELITE LACROSSE ACADEMY , ST. JOSEPH'S COLLEGE OR ITS RESPECTIVE OFFICERS, AGENTS, REPRESENTATIVES, SUPPLIERS/VENDORS AND/OR ASSIGNED FOR ANY DAMAGES WHICH MAY BE SUSTAINED OR SUFFERED BY ME IN CONNECTION WITH OR ENTRY IN AND/OR ARISING OUT OF MY TRAVEL TO PARTICIPATE AND RETURN FROM THE FACILITY.

OR SUBMIT TO:

PARENT SIGNATURE:

PAYMENT DETAILS:BALANCE DUE APRIL 30TH