MCPARC

Coach Brogdon's Silverheels® Lacrosse
and the Marion County Parks and Recreation Commission

Learn the basics of this dynamic, fast paced game,
Coached by LACROSSE professionals with many years of experience

The coaching staff is led by Jarrott Brogdon. Brogdon is an experienced coach and the current coach of the Fairmont Senior boys team. FSHS won the 2009 WVSLA State Championship and made it to the semifinals in 2010..He has started several lacrosse teams and programs during his career. He has coached at Trinity, Bethel Park, and Peters Township, all in Western Pennsylvania. In 2009 he was inducted into the Pennsylvania Sports Hall of Fame.

Fee: $155.00 at Registration. Fee includes: Take-home lacrosse stick,
lacrosse ball, reversible jersey, daily instruction & attendance certificate.
Our lacrosse safety equipment available for students during class.

Please Bring Daily: Tennis shoes or non-metal cleats, cup, mouthpiece
Game clothing (T-shirt & sport shorts), and full water bottle.

To Register: Complete below form, enclose check payable to "MCPARC"
Mail to: MCPARC, 319 Monroe St., Fairmont, WV 26554

Silverheels® Lacrosse at MCPARC - JUNE 2010 Learn to Play Camp Registration/Medical release form

Player Name ____________________________________ Age in July ____ Current school grade _______________________

Home Address ____________________________________________ City _________________ State / Zip _____________

Home Phone # _________________________ Work # _________________________ Cell # _________________________

I have enclosed non-returnable fee of $155.00
I have listed (on the reverse of form) any known Medical Condition (s) and Physician-prescribed medication (s) of the above named player
and attest the player is medically insured, and player be injured, that emergency medical treatment and any necessary transport to a medical
facility is authorized in my absence.

Today's Date: _____________________ Required Parent / Guardian Signature: __________________________________________________