M|11 Camps

Private Instruction Price: Based on Selection Click Here if you do not have a USA Lacrosse number. USA Lacrosse Number: *Required   Contact Name: *Required   Player First Name: *Required   Player Last Name: *Required   Contact Phone: *Required   Player Grade: *Required   Address: *Required   City: *Required   State: *Required   Zip: *Required   Email: *Required   Alt. Contact Name / Number: *Required   Player Birth Date: *Required   Player Age: *Required   Player Gender: *Required   Any Medical Conditions?:*Required      Allergies? (please list):*Required      Primary Insurance Carrier: *Required   Group Number: *Required   I give Miller Lacrosse permission to use, at their discretion, any photos or video taken at this event in conjunction with future publication. A selection is required. Select Permission option No Yes    Click Here to Read Code Of Conduct Read Code of Conduct:   Yes Click Here to Read Waiver Read Waiver:   Yes Qty