2015 CCBC Essex Men's Lacrosse Prospect Day

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December 5, 2015

CCBC Essex Campus
7201 Rossville Blvd. Baltimore, Md. 21237

$40.00 per participant

10:00 AM - Doors Open/Check In at Wellness & Athletics Center

ZIP Code *

Email address *

Cell Phone Number *

Address 2

City *

Address 1 *

Last name *

State *

First name *

High School *

Year (Freshman, Sophomore, Junior, Senior) *

Position *

Pinney size *

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Are you 18 or older? *

If Yes, enter 'N/A' for Parent/Guardian signature. If under 18, your parent or guardian's information must be entered.

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Parent/Guardian Name (First & Last) *

Parent/Guardian Signature *

Please enter your full legal name. This will serve as your e-signature and confirm you are the parent or guardian of the participant listed above.

Parent/Guardian phone number *

Parent/Guardian email *

Liability Waiver

I agree not to hold the Community College of Baltimore County liable for any injuries or damages arising from participation in this program. I understand by printing my name below I am submitting my online signature. *

Yes

Parent/Guardian Full Name *

Participant Full Name

If under 18, enter 'N/A' and have your parent/guardian sign.

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