Registration for Girls Lacrosse Camp

Please fill out the form below to register for Lees-McRae's 2013 Girls' Lacrosse Rising Stars Camp, scheduled for June 14-16. The Rising Stars Camp is for players currently enrolled in middle school or high school.  This camp is for beginning, intermediate and advanced campers who want to develop their skill in preparation for their high school team.

Campers will stay in Lees-McRae’s residential halls with all meals provided; a day camp option is also available. Cost of the camp is $285 for residential campers, $165 for day campers. Each camper will receive a Lees-McRae women’s lacrosse reversible jersey to take home.

Personal Information

Email address *
First name *
Last name *
Address 1
Address 2
ZIP Code
Home Phone
Alternate Phone
Shirt Size *
Covered under Medical Insurance? *
If yes, please specify your provider and policy information in the fields below
Insurance Provider *
Enter N/A if not applicable
Policy Holder Name *
Enter N/A if not applicable
Policy Number *
Enter N/A if not applicable

Custodial Parent/Guardian Information

Registrant is in the custody of
If provided options do not apply, complete the next field
  Both parents
  Mother only
  Father only
Mother/Guardian Name
Daytime Phone
Work Phone
Father/Guardian Name
Daytime Phone
Work Phone

Medical Information

Please list medications *
Please list allergies *
List any known physical limitations or concerns that we should be aware of

Emergency Contact Information (other than guardian)

Full name
Home Address 1
Home Address 2
Primary Phone
Alternate Phone
Relationship to camper

Waiver of Responsibility

I agree Lees-McRae College and its athletic department is released from liability in connection with medical treatment and unavoidable accidents.  Lees-McRae College Girls' Lacrosse Rising Stars Camp also has my permission to use necessary medical measures in the event of an emergency, for which I will be financially responsible.

I fully understand the inherent risks involved in the activities my child will be participating in for this lacrosse camp. I accept all risks including those activities preliminary and subsequent to the activity.  

I do hereby further declare [provide child’s full name below] to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent their participation, with or without reasonable accommodation of any disability, in any of the activities and programs of the Lees-McRae College Girls Lacrosse Rising Stars Camp. I do hereby assume all responsibility for this child’s participation and activities, and his/her use of equipment in activities. *

Also, I give the Lees-McRae College women’s lacrosse program permission to utilize my child's photograph or likeness in camp promotional materials.

Parent or Guardian Electronic Signature *
Date *


Lees-McRae Athletic Camps


Lees-McRae College Girls Lacrosse Rising Stars Camp
Attn: Ray Cameron
PO Box 128
Banner Elk, NC 28604

* = required field