TRI-STATE AREA

YOUTH FOOTBALL CAMP

Presented by Allegany High School
Coaching Staff and Football Players

REGISTRATION FORM

Participant’s Name:____________________________________Age:_____
Address:______________________________________________________
School_________________________________Grade(Fall 2009):________
Previous Experience in Organized Football:______Yes_______No
If “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 which
We 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 Liability
I, the parent/guardian of the above named individual, acknowledge that participation in
the 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 primarily
administered by persons who volunteer their time, rather than by paid professionals. In
consideration for accepting the participation of said individual in its program, I hereby
release, discharge, and hold harmless Tri-State Area Youth Football Camp volunteers,
coaches, players, and all other representatives, from any claims arising out of, or relating
to, 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:_________________________________