Register

The Lake Champlain Lakers program offers three options for your son/daughter to assist in improving their game. Please check the appropriate option, complete the registration form and submit. After this form is submitted, you will be sent to a registration confirmation page. A duplicate confirmation email will be sent upon submission of this registration form to the email address provided.

PARTICIPATION OPTIONS: Please select 1 of the following options below:
OPTION #1		Camp Only $260.00 Due at Registration*
My child will participate in the 10, two-hour sessions. We are NOT interested in the travel team
OPTION #2		CAMP AND TRAVEL TEAM $260.00 Due at Registration*
My child will participate in the 10, two-hour sessions. + If selected, we will travel. Additional $235.00 Due By 04/18/15 (Boys & Girls)**
OPTION #3		TRAVEL TEAM ONLY $110.00 Due at Registration*
My child wishes to try out for possible team placement. + If selected, we will travel. Additional $385.00 Due By 04/18/15 (Boys & Girls)**
*THE TOTAL TRAVEL TEAM COST (OPTION #2 OR OPTION #3) IS $495.00 TOTAL PER PARTICIPANT*
PAYMENT DATES * = DUE AT REGISTRATION **= BOYS & GIRLS DUE 04/18/15 (Remaining Balance is Due)

OPTIONAL: TOURNAMENT CONCESSION SIGN-UP The players and their families, who participate in the travel portion of the program, are asked to assist at the home tournaments. Please mark your calendars and plan on working a minimum of two hours at one or both tournaments. Please select your preference:
Boys Home Tournament		May 2nd & 3rd
Girls Home Tournament		April 18th and 19th

2015 LAKE CHAMPLAIN LAKERS AAU BASKETBALL REGISTRATION FORM
Name	*
Current Age (i.e 16)	*
D.O.B. (i.e 03/20/1995)	*
Grade	*
Gender	*	Female Male
Height	*
Weight	*
T-Shirt Size	*
Home Phone #	*
Street Address	*
City	*
State	*
Zip Code	*

EMERGENCY CONTACT INFORMATION:
Full Name #1	*
Phone #1	*
Full Name #2
Phone #2

ATTESTATION: I, being the parent/guardian of the above mentioned minor, do herby certify that my child is in good health and may participate in all camp activities. I hereby appoint the Lake Champlain Lakers AAU Basketball Inc. to act on my behalf in authorizing medical attention. LAKE CHAMPLAIN LAKERS WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS. AAU membership provides each member with accident insurance (which is secondary and comes into force after any primary coverage) for all properly sanctioned AAU events. AAU membership also provides each member with similar coverage during supervised practices of member clubs. Specific details on coverage, exclusions and how to file claims can be obtained from your local AAU Association.
Relationship of person completing this form to the Participant being registered?
Please Select	*	Parent Guardian
Parent/Guardian Name	*
Attestation Date	*
Email Address	*
Primary Insurance Information Covering Participant
Company / Policy Name	*
Insurance Identification Number	*

Note: Enter Security Code Without Spaces. Security Code Is CaSe Sensitive.
Security Code	*