I, the undersigned, as parent/guardian of ____________________________________ _ (camper) hereby authorize the camp coaches to act for me in the event of a serious

emergency and I hereby waive and release the camp and its directors from any and all liability for injuries and illnesses incurred while attending camp. In addition, I certify that my child is in good health and is able to participate in all program activities. Furthermore, in the event of an emergency requiring medical attention, I shall pay for the services rendered.

Name_______________________________ _ Age___________Grade in Fall 2011________ Date of Birth _______/_________/________ Parents Name _____________________________________ Address

2011 Kennedy Road 2nd Annual Football Youth Camp

Where:
280 Kennedy Road Griffin, Ga. 30223

T-Shirt Size (Circle One) S M XXXL L XL XXL

When: July 11-14, 2011 Time: 9:00 a.m. 12:00 p.m. Cost: $30 .00
(Money order, cashiers check or cash only) * Make money order payable to Kennedy Road Middle School

Parent Phone

Parent Signature Date

(H)__________________________________ (C)__________________________________ _ Email_______________________________ _

Payment Method: Money Order or Cashiers check Only! Make payable to: Kennedy Road Middle School Mail form and payment By July 1st to: Kennedy Road Middle School 280 Kennedy Rd. Griffin Ga. 30223

Emergency Contact_____________________________ __ Emergency Phone ______________________ Football Position: Offense:____________________________ __

Gear required: Cleats, Shorts, and Tshirt. No pads or Helmet needed. Daily activities include all fundamentals of football and skill competitions All skill levels are encouraged to attend