Please mark the appropriate program, session,
location and fill out the form completely.

Location & Date of Camp:
Last Name:
First Name:
Street Address:
City:
State/Province:
Zip Code:
Area Code:
Phone # :
Email:
Gender: Male:Female:
Age when camps starts required:
Birth Date:
IMPORTANT: If you register online, you still need to fill out a
medical form and mail it in or bring it with you to camp. Medical Form
I understand that Lake Placid Soccer Centre is not responsible for accidents resulting in medical, dental or other expenses, including loss of personal items. The camp participant will be held responsible for all property damage and may be sent home without a refund for violation of camp rules. The applicant must be in good health and be able to participate in the physical activity of a vigorous program. A health form to be completed by the applicant's physician will be sent with the camper's confirmation letter and must be presented before or on arrival at the camp. A non-refundable deposit is required for this application to be accepted, with the balance due on or before the first day of camp. In the event I cannot be reached, it is permissible for LPSC, to have a doctor/hospital treat my child for medical reasons.
   I Agree
Health Insurance Company:
Policy Number :
Group Number :
Coments:

Lake Placid Soccer Centre
PO Box 847
Lake Placid, NY 12946
800-845-9959  +   518-523-4395
fax: 518-523-9476