YOUTH QUARTERBACK CAMP APPLICATION FORMJune 12, 2011
Name Address City State Zip Home Phone Cell Phone Email Position QB Ht Wt Grade (Fall 11) Age DOB Current School School player will attend in Fall 2011 (if different) Football Team 2010 Coach's Name T-Shirt Size Youth S Youth M Youth L S M L XL XXL Emergency Contact Information Parent/Guardian Name Parent Daytime Phone Health Insurance Name Policy Number Please explain if there are any restrictions on participation DISCLAIMER / CAMP RELEASE My son has permission to attend the Jerry Franks Football Camp. I am aware that my son must have current and active medical insurance before he can attend. My son is free from any medical or emotional problems that may affect his ability to safely participate in your camps activities. In the event of any injury or illness which my son requires medical care, I authorize the camp staff to act for me and to obtain/or administer any medical care or treatment deemed necessary and appropriate. I hereby waive and release Jerry Franks Football Camps, its owners, staff and sponsors, from any and all liability for any injury incurred while at the camp. I authorize Jerry Franks Football Camps to use any photographs or articles about my son for publicity purposes. I understand a full refund will be received if cancel notification is made to Jerry Franks on or before May 29, 2011. I also understand that there are no refunds for cancellations after May 29, 2011. I agree with the above Disclaimer
