WING-T
June 19
�21, 2006 at
Mail
Registration to :
c/o Cindy Adams
Phone: 535-1968 /E-mail:
[email protected]
Name:_____________________________
Phone:_____________________________
Address:___________________________
__________________________________
Middle School you
attend:_________________ Grade in Fall
2006______________________
Payment/Deposit of
$__________ is included.
Height:___________
Weight:___________
T-Shirt Size (circle
one): YM YL AS AM
Parent�s
Name________________________
Home Phone_________________________
Home
Address__________________________________________________________
Work Phone (Mom)_____________________ Work Phone
(Dad)______________________
Emergency Contact:______________________________________________________
Full camp cost or a
deposit must accompany this application.
A deposit of $50 per camper is due by June 5, 2006. The balance ($75) will be due at
check-in on June 19th. There is a
late registration fee of $25 for all applications received after June 5th. No refunds (other than medical)
after June 5th.
Medical
Release Form
My son/daughter does have my
permission to attend the Coach Moore Wing-T Football Camp. I hereby release and exonerate and
discharge the camp and its employees from any injuries incurred in the
camp. I, the undersigned
parent/guardian, do hereby delegate to the Coach Moore Football Camp its
employees or agents the authority to seek, obtain, and approve any medical care
and treatment for the below named minor, which in their judgment is necessary
for the health and well-being of said minor during his/her attendance at the
camp. Further, I agree to hold the Coach Moore Wing-T Camp, its employees, or
agents harmless for any liability arising out of any good faith actions taken in
seeking and obtaining medical care and treatment for the below named
minor.
Any costs not covered by your
insurance are the sole responsibility of the parent or
guardian.
Camper�s
Name_____________________________________________________________
Any restrictions/medical problems or
allergies?___________________________________________________________________
Parent�s
Signature___________________________________________________________
Insurance Company_____________________ Insurance
Co. Phone_________________
Name in which policy is listed:________________________________________________
Policy
#______________________________Group#_______________________________