South LakesAthletic Boosters Summer Camps 2016

(Note: you can also register online at

Camper Name / Age as of 7/1/2016 Grade in Fall 2016
T-Shirt Size (Adult S, M, L, XL, XXL) – not all camps provide shirts / Home Phone Number
Home Address – Street / Home Address – City, State, Zip
Parent/Guardian Name / Parent/Guardian Email
Parent/Guardian Cell Phone
Emergency Contact Name / Emergency Contact Phone

Camp Selection (Grades as of Fall2016, Ages as of 7/1/2016)- All camps at South Lakes HS unless otherwise noted

Boys Basketball (at Rachel Carson MS) / 6/27-7/1 / 9 am – 2 pm / Rising 2nd-10th graders / $135
Boys Basketball / 7/5-7/8 / 9 am – 2 pm / Rising 2nd-8th graders (no high schoolers) / $110
Boys Basketball / 7/11-7/15 / 9 am – 2 pm / Rising 2nd-10th graders / $135
Field Hockey / 7/11-7/15 / 8:30 am – 12 noon / Rising 5th-11th graders / $135
Volleyball / 7/11-7/15 / 5 pm – 9 pm / 11-15 year old girls and boys / $125 ($100 each additional camper from same family)
Youth Football (non-contact) / 7/18-7/22 / 9 am – 2 pm / 8 year olds-Rising 9th graders / $125
Girls Basketball / 7/18-7/22 / 9 am – 2 pm / Ages 7-15 / $135 (2 campers same family $240, 3 campers same family $315)
Girls Basketball / 7/25-7/29 / 9 am – 2 pm / Ages 7-15 / $135 (2 campers same family $240, 3 campers same family $315)
Total for all camps this camper is attending – please add carefully so that we don’t have to return your form. Registration is not final until payment is processed. Thank you! If using the sibling discount for Volleyball or Girls Basketball, please tell us the names of the siblings below. (We need a form for each camper, but giving us the sibling names will allow us to tie the forms together for the discount.)

Since camp directors need to insure adequate staffing and appropriate supplies for their camps in advance, refunds will not be issued after July 1, 2016.

Agreement/Medical Waiver: I hereby state that my childis in good normal health and has my permission to participate in all activities of this camp. In addition, I authorize the South Lakes Camp Staff to act for me in securing medical treatment for my child in the event of injury or illness. A registration requires that a parent/guardian sign below to agree that in case of an accident involving my child while attending any South Lakes Camp they release the Camp, Sponsor, Counselors and Director from any and all liability, and that the South Lakes Athletic Boosters cannot assume responsibility for medical, dental or other health expenses incurred as a result of my child’s participation in camp.

______(Parent/Guardian Signature)

Please send this completed form and a check for the total fee to:

SLHS Athletic Booster Club

Attn: Treasurer

12415Wendell Holmes Rd

Herndon, VA 20171Questions? Email