Rates:-   1 day £90, 2 days £110, 3 Days £130, 4 Days £150, 5 days £160, Further days £20 extra per day

If you are paying by cheque please make it payable to: ‘Chiswick Lacrosse’ and send it to:

Chris Southwell, Bryn Deri, Haverfordwest, Pembrokeshire, SA62 6ND

Alternatively if you wish to pay using Internet Banking please set up payment to:

HSBC Bank - Chiswick Lacrosse - Sort Code: 40-44-39 - account number  - 81635638

Do quote your Daughter’s name in the reference

Check box if you would like your daughter to have an Opro mouthguard fitting 22nd and 29th Aug. Please read note in full details

Please indicate each day your daughter is attending by checking the boxes

Week 1 Aug 14th to 18th

Week 2 Aug 21st to 25th   

Week 3 Aug 28th (Bank holiday) to 1st Sept

Mon Aug 14th

Mon Aug 21st


Current school

Home Address

Address 2



Post code

Date of birth


Emergency phone

Email address please

Highest playing experience

Does your daughter  have a Lacrosse stick ?

We do have some for borrowing.

Cost for number of days (see below)

Total amount  to pay

Going Home arrangements

Any other comments

Please indicate how you wish to pay:

Fri Aug 18th

Thu Aug 17th

Wed Aug 16th

Tues Aug 15th

Fri Aug 25th  

Thu Aug 24th   

Wed Aug 23rd   

Tue Aug 22nd (Opro)

Mon Aug 28th (Bank holiday)

Tue Aug 29th (Opro)

Wed Aug 30th

Thu Aug 31st   

Fri Sept 1st

My daughter may play without goggles

I will provide goggles for  my daughter to wear

Please indicate your preference for your daughter regarding wearing of goggle. Click here for my comments

Is your daughter applying as part of a squad?

Squad Name

Receipt of form and of payment will be made as swiftly as possible by email or phone if no email address is given

Medical conditions and/or medications

Squad bookings now closed

New school if starting next September

Plus £5 Annual membership fee.  For further details please click here

No autoresponse, I  will reply as soon as I can.

Please note we have never had to refuse an application. We have plenty of pitches and about 50 staff to call on.

Online Application form for Girls Lacrosse Camp 2017

Use Tab key to move through the form

We take bookings right up to the day of the camp. We have plenty of space and lots of staff to call upon. In 30 years of running these camps we have never had to turn anyone away.

Chiswick Lacrosse The Friendly Club