Jags Championship Youth Football Camp

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2019 Jags Championship Youth Football Camp Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Birthdate:

* School:

* Grade:

* T-Shirt Size:

Sibling First name:

Sibling Last name:

Sibling Birthdate:

Sibling School:

Sibling Grade:

Sibling T-Shirt Size:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Email:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* Email:

* Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

My child _____________________ has my permission to participate in the Jags Championship Youth Football Camp on June 24-27 at Northwest High School. In the event that I cannot be contacted, I authorize emergency medical technicians to administer the necessary first aid immediately to my child, should he become injured or sick during the camp and require treatment. I understand that Northwest High School and its staff, MCPS, Germantown Sports Association, coaches, and staff are not responsible for any injuries that may occur during the camp.
I acknowledge that at the Jags Championship Youth Football Camp my child will participate in a sport that may involve among other things, physical contact of the body with other persons or objects, including the ground. I understand that at the Jags Championship Youth Football Camp my child may incur a risk of injury. I specifically waive, give up and release the Jags Championship Youth Football Camp, its directors, employees and anyone on the premises on which the Jags Championship Youth Football Camp is held, from liability for any claims or damages which I or my child may have for injuries or illness that may be sustained at the Jags Championship Youth Football Camp.

I/we agree with the above *

Signature:

Date:

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IMPORTANT: Online Payment with credit cards is not active for this form

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2019 Jags Championship Youth Football Camp Registration Form