Name *
Name
Address *
Address
Parent/Guardian *
Parent/Guardian
Please enter name of parent/guardian of camper
Parent/Guardian Signature *
Parent/Guardian Signature
By entering your name here, you are signing this form
Telephone Number *
Telephone Number
Equipment Rental *
$25 Fee to rent equipment. Please select Yes or No
MEDICAL INFORMATION
MEDICAL INSURANCE All campers must be covered by their parent’s medical insurance. Camper’s medical insurance forms must be completed BEFORE participating in any camp activity. MEDICAL RELEASE I hereby register my child for the Block & Tackle Football Camp and authorize the staff to direct him in participation in all camp activities. My child has no medical problems that may affect his ability to participate in your program. The camp staff is authorized to attend to any health problem or injury my child may incur while attending the camp. I further acknowledge that the Block & Tackle Football Camp, its’ owners, coaches, and anyone associated with the Block & Tackle Football Camp, will not be liable for any damages resulting from injuries or illness sustained at the Block & Tackle Football Camp or Somers High School.
Player's Name *
Player's Name
By entering your name here, you are signing this form
Please enter the camper's emergency contact name and phone number
Photo & Video Disclaimer
Block and Tackle reserves the right to use any photograph/video taken at any event sponsored by Block and Tackle, without the expressed written permission of those included within the photograph/video. Block and Tackle may use the photograph/video in publications or other media material produced, used or contracted by Block and Tackle including but not limited to: brochures, invitations, books, newspapers, magazines, television, websites, etc. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent or legal guardian A person attending a Block and Tackle camp who does not wish to have their image recorded for distribution should make their wishes known to the photographer, and/or the event organizer by contscting Block and Tackle at http://www.blockandtacklefootballcamp.com/contact/ Thank you for your understanding and cooperation!