Foot Camp Regist Form

TRI-STATE AREA YOUTH FOOTBALL CAMP Presented by Allegany High School Coaching Staff and Football Players

REGISTRATION FORM Participant’s Name:____________________________________Age:_____ Address:______________________________________________________ School_________________________________Grade(Fall 2009):________ Previous Experience in Organized Football:______Yes_______No If “Yes” how many years of experience:_____________________________ Shirt Size: (circle one) YOUTH: S M L ADULT: S M L XL Name of Parent/Guardian/Other Responsible for Child: _____________________________________________________________ Address:______________________________________________________ Phone Number(s):______________________________________________ Contact in Case of Emergency:____________________________________ Emergency Contact Phone: _______________________________________ Does the participant have any physical or health-related conditions for which We should be aware, or for which special accommodations need to be made: _______Yes_______No If “yes”, please explain:_____________________ Fee: $30.00 ($25.00 for siblings) Cash______Check_______Ck#_______ Release of Liability I, the parent/guardian of the above named individual, acknowledge that participation in the above named athletic event necessarily involves risks of physical injury. I further acknowledge that the program of the Tri-State Area Youth Football Camp is primarily administered by persons who volunteer their time, rather than by paid professionals. In consideration for accepting the participation of said individual in its program, I hereby release, discharge, and hold harmless Tri-State Area Youth Football Camp volunteers, coaches, players, and all other representatives, from any claims arising out of, or relating to, any physical injury that may result to said individual while participating in any TriState Area Youth Football Camp sponsored events, including, but not limited to, any physical injury caused by the negligence of any officer, referee, or coach while performing his/her duties during any warm-ups, practice, games, or tournaments. Signature Affirms Acceptance of Release of Liability:____________________________ Date Signed:_________________________________