Penn Yan Boys & Girls Lacrosse Day Camp

August 3-5th // 9 am – 3 pm // Ages 7-18

$135

All skill levels welcome – players will be split up by age group Penn Yan Academy

Brice Queener Sylvia Queener Brice is the current Head Coach for the Rhode’s Women’s SAA D3 Brett is the current Men’s Assistant Sylvia is currently the Assistant Championship Lacrosse team. Coach at Albany University and Women’s Coach at Pomona-Pitzer. starting goalie for the . Brice played at Sylvia played at Limestone College and helped them to four straight Brett has won the MLL championship and was the 2013 Carolina Conference NCAA quarterfinal appearances. twice, has been the MLL All Star six Co-Player of the Year and NCAA Brice has also played for Team times and has been an All-American Division II All American. USA Indoor, The Rochester Rattlers, and Lacrosse Personality of the Year. and the /Hamilton Nationals Sylvia has coached at Penn Yan of the MLL. He is recognized as the best stick trick Academy where she specializes in wizard in lacrosse – he’s won the MLL draw work and has helped the Brice also coaches current NCAA stars stick trick challenge twice. Pomona-Pitzer Sagehens set a school like Jeremy Noble and Zach Miller. record of 16-5 and make their first Register Online @ NCAA tournament appearance.

www.queenerlax.com

QUEENER LAX PENN YAN LACROSSE DAY CAMP SUMMER 2015 Paper Registration

Player Name:______Position:______Age:______Address:______Email Address: ______Phone Number:______Emergency Contact Name:______Relationship:______Emergency Contact Phone Number:______Insurance Carrier:______Medical Conditions/Allergies:______Person Picking up Player from Session:______

Waiver:

In consideration of your acceptance of this application, we (or I) (whether one or more) hereby release Queener Lax LLC and all Queener Lax LLC employees from all claims on account of any injuries which may be sustained by our (or my) child while attending the 2015 Queener Lax Penn Yan Girls and Boys Lacrosse Camp, and we (or I) agree to indemnify Penn Yan Academy and its employees for any claim which may here after be presented by our (or my ) child as a result of such injuries. We or (I) give permission for Queener Lax LLC medical personnel to administer first aid and adequate medical care in the event of any injury or illness. I understand that lacrosse is a contact sport and there is a realistic risk of injury; including but not limited to: sprains, breaks, soreness, paralysis, concussions, and release Queener Lax LLC and Penn Yan Academy of all liability.

Parent/Guardian Name: ______

Parent/Guardian Signature: ______

Return form with check for $135 addressed to: Queener Lax LLC

113 Highland Drive

Penn Yan, NY 14257