2014 SUMMER FOOTBALL CAMP

Wednesday, JULY 30
th
& Thursday July 31
st

5PM 8PM
Murdock Middle High School
3 Memorial Drive, Winchendon, MA
AGES 5 and up!
Grouped by Age
Teaching and Reviewing Progression
Passing, Catching, Kicking, Blocking, & Tackling
In order for participants to receive a camp shirts
Please send paid registration by July 9
th
.
(Walk ins are welcome that day we cannot guarantee a shirt for them.)

Please be sure to include the form below and sign
the reverse side release form needed for each participant!



Participant Name:______________ Parent/Guardian:________________
Phone:________________ Email:_______________________________
Mailing Address:_____________________________________________
Participant Age:___________________ Football Experience (circle one) Yes / No

T-Shirt Size: YS ___ YM ___ YL ___ AS ___ AM ___ AL ___ AXL ___

Extra T-Shirts x $10 each= _______

Total Cost = $_______

Checks should be made payable to MMHS Varsity Football and can be mailed to:
Only
$30 to
attend!
10 Bluebird Road, Winchendon, MA 01475

For questions, call Andy Dupuis at (978) 660-9266 or email him at aased@aol.com

WINCHENDON PUBLIC SCHOOLS
OFFICE OF THE SUPERINTENDANT

PARENTAL/PARTICIPANT CONSENT, RELEASE FROM LIABILITY AND INDEMNITY
AGREEMENT
I, the undersigned parent/guardian/legal representative of
_____________________________
Participants Name
do hereby consent of his/her participation in Murdock Football Camp to be held at Murdock Middle High
School on July 30 and 31, 2014, and in consideration of his/her being permitted to so participate, I, on
behalf of myself, my heirs, my agents, my representative and on behalf of
______________________________
Participants Name
do forever RELEASE, acquit, discharge, and covenant to hold harmless the Town of Winchendon, and its
employees, servants and agents, as well as the Winchendon School Committee, its former and current
members, and its employees, servants and agents, from any and all actions, rights of action, causes of action,
charges, and/or claims, in any way related to, arising from and/or growing out of, directly or indirectly, all
known or unknown personal injuries or property damage or death, which I may now or hereafter have as the
parent/guardian/legal representative of said minor, as well as any actions, rights of action, causes of action,
charges, and/or claims which said minor has or hereafter may acquire, either before or after he/she reaches
the age of majority, resulting from, relating to, or in any way connected to, his/her participation in the
Murdock Football Camp run by, sponsored by or related to the Winchendon Public Schools.
In addition, I, as parent/guardian/legal representative of said minor, agree to indemnify the Town of
Winchendon, and its employees, servants and agents, as well as the Winchendon School Committee, its
former and current members, and its employees, servants and agents, in the event that any action, charge,
and/or claim, is brought against the foregoing, which is in any way related to, arising from and/or growing
out of, directly or indirectly, my son/daughters participation in the Murdock Football Camp run by,
sponsored by or related to the Town of Winchendon Public Schools.
___________________________________________ ________________________________________
Signature of Parent Date Signature of Participant Date

Association Name: ___________________________