TRI-STATE AREAYOUTH FOOTBALL CAMP

Presented by Allegany High SchoolCoaching Staff and Football Players

REGISTRATION FORM

Participant’s Name:____________________________________Age:_____ Address:______________________________________________________ School_________________________________Grade(Fall 2009):________ Previous Experience in Organized Football:______Yes_______NoIf “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 whichWe 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 LiabilityI, the parent/guardian of the above named individual, acknowledge that participation inthe 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 primarilyadministered by persons who volunteer their time, rather than by paid professionals. Inconsideration for accepting the participation of said individual in its program, I herebyrelease, discharge, and hold harmless Tri-State Area Youth Football Camp volunteers,coaches, players, and all other representatives, from any claims arising out of, or relatingto, any physical injury that may result to said individual while participating in any Tri-State 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:_________________________________