Earl Bennett Football Camp 7/13/13
Saturday, July 13, 2013 from 8:00 AM to 1:00 PM
San Francisco, California
London, United Kingdom
Earl Bennett Football Camp Registration Form
July 13, 2013 – Parker High School
***Important to PRINT clearly and complete entirely***
Participant Name__________________________________ D.O.B__/___/___
School_______________________________________ Grade ____________
Telephone Number (_____) _________________
T-Shirt Size (circle)S M L XL XXL
Emergency Contact Information
Name_____________________________ Relationship____________ Contact Number (______)
Parent Consent & Release Form
The undersigned, being a parent or legal guardian of the child requesting camp admittance, does hereby affirm that the applicant is in good health, and suffers from no illness, disability or condition that requires the taking of medication on a regular basis unless that condition is disclosed and approved. Furthermore, the undersigned has no knowledge of any reason the application cannot participate in vigorous physical activity. The undersigned hereby expressly agrees to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to allowing any camp supervisors to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent, recognizing that no entity involved with the Earl Bennett Football Camp or Legion Field Stadium assumes responsibility for, nor do they have any liability for, the medical assistance and care selected or provided. No primary medical insurance is provided by the Earl Bennett Football Camp, Legion Field Stadium.I understand that, as a condition of admittance as a camper, the undersigned, on behalf of all parents and guardians, and on behalf of the applicant, hereby releases the Earl Bennett Football Camp and Legion Field Stadium and all other employees, volunteers, vendors, sponsors or agents of the camp from any and all liability from injury or illness, mental or physical, suffered by the camper during or related to camp activities including bus trips provided by the city, unless caused by willful act or gross negligence by the person or entity against whom the claim is made.
Photo Release: I hereby grant authorization to the Earl Bennett Football Camp, City of Birmingham, and its agents and/or vendors to use photographs of myself and/or child for publicity purposes.
Parent/Guardian Signature_____________________________ Date _____/_____/______
Please return the completed form and bring day of camp!! Will not be able to participant without completed form.