Rates:-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 13th to 17th

Week 2 Aug 20th to 24th   

Week 3 Aug 27th (Bank holiday) to 30th

Mon

Mon

Name

Current school

Home Address

Address 2

Town

County

Post code

Date of birth

Phone

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 arrangements

Any other comments

Please indicate how you wish to pay:

Fri

Thu

Wed

Tues

Fri

Thu

Wed

Tue (Opro)

Mon (Bank holiday)

Tue (Opro)

Wed

Thu

Fri

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

Medical conditions and/or medications

New school if starting next September

Plus £5 Annual membership fee.click here for full details

No auto-response,

We will reply as soon as we 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 2018

Use Tab key to move through the form

Chiswick Lacrosse The Friendly Club

Chris Southwell

Chiswick Lacrosse

Brynderi

Pembrokeshire

SA62 6ND

07958200128