Rippin' Rope Camp Registration

Complete the form below to register for the Rippin' Rope Lacrosse Camp of your choice.

Enter A Coupon Code

Choose Your Camp *

Billing Information

Title

Parent First Name *

Parent Last Name *

Suffix

Address Line 1 *

Address Line 2

City *

State *

Zip *

Phone *

Email *

Second Parent Information

Title

Second Parent First Name

Second Parent Last Name

Suffix

Player Information

Player First Name *

Player Last Name *

Camper Gender *

Player Email Address

Grade in 2019-2020 School Year *

School for 2019-20 school year (or most recent)

Player Date of Birth (MM/DD/YYYY) *

Complimentary camp reversible size - Select One

Small/Medium

Large/XL

Preferred Position - Select One

Attack	Midfield
Defense or LSM	Goalie
Any

Years playing lacrosse prior to camp

Recreation Team and/or School team

Rippin Rope Waiver

By checking the box below, you agree, warrant and covenant as follows: Rippin' Rope Lacrosse Camps Waiver and Release In consideration of my participation in Rippin' Rope Lacrosse Camps (hearafter referred to as RRL, LLC) sanctioned events, I agree to the following: 1. WAIVER AND RELEASE (Release of Liability and Assumption of Risk Agreement): I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses, associated with participation in a lacrosse event. I willingly agree to comply with the stated and customary terms and conditions for participation and if I observe a significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official. I further agree on behalf of myself, my heirs, and personal representatives, that the host organization and sponsors of any RRL, LLC sanctioned event, along with the coaches, volunteers, employees, agents, officers and directors of this organization, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event. I fully understand the terms of this Release of Liability and Assumption of Risk Agreement and that I have given up substantial rights by signing it. 2. MEDICAL ATTENTION: I hereby give my consent to RRL, LLC and the host organization of any RRL, LLC sanctioned event to provide, through a medical staff of its choice, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my participation in RRL, LLC sanctioned events. In addition, I agree that I shall be responsible for the cost of any medical care not covered by Bollinger/US Lacrosse and will reimburse RRL, LLC or its representatives who might incur costs on behalf of myself or my child. 3. READINESS TO COMPETE: I will only participate in those competitions for which I believe I am physically and psychologically prepared to compete.

I agree to the above waiver

Yes

Credit Card Information

Credit Card Number*

Expiration Date*

Card (CVV) Code*