Summer 2008

Please return completed registration form and $300 deposit to:
Mark Goldsmith
The Old North State Lacrosse School
PO Box 2254
Jamestown, NC 27282		 Make checks payable to:
The Old North State Lacrosse School
Balance is due by June 13th, 2008.
Division I Fees
_ Overnight ($430)
_ Day Camper ($375)
 
Division II Fees
_ Overnight ($375)
_ Day Camper ($315)
 
Last Name:
First Name:
Address:
City:
State:
Zip:
Grade As Of September 2008:
Position:
Roommate (One Only):

Parent Email Address:
(Print Neatly )
Current or Future High School:
(As of September 2007)
I hereby request that my child named above be admitted to the Old North State Lacrosse School and authorize the directors to act for me according to their best judgment in any emergency requiring medical attention.
 
Parents Signature: ___________________________________________________________________
Home Phone:
Office Phone:
Insurance Company:
Policy #:

For further information call or write:

The Old North State Lacrosse School
P.O. Box 2254
Jamestown, NC 27282
Phone (336) 454-2904
(919) 363-9367 • (919) 858-9344
http://www.nclax.com/oldnorthstate

©2008 Old North State Lacrosse School