Lower Merion Football

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Lower Merion Football Skill Development July 18th - July 22nd

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

* T-Shirt Size:

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
I hereby authorize JOE AUGUSTINE and the Staff off the LOWER MERION YOUTH FOOTBALL CAMP to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release the camp and LMSD from any and all liability for any injuries or illnesses incurred while at the camp.

I/we agree with the above *

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Lower Merion Football Skill Development July 18th - July 22nd