Jerry Franks Football Camps
YOUTH CONTACT CAMP APPLICATION FORM
July 25, 2011 – July 28, 2011
Name
Address
City
State
Zip
Home Phone
Cell Phone
Email
Ht
Wt
Grade (Fall 11)
Age
DOB
Current School You Attend
School you 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 July 11, 2011. I also understand that there are no refunds for cancellations after July 11, 2011.
I agree with the above Disclaimer
