Big South Football Camp July 30th & 31st 2005
Camper Name:_____________________________________________________________________________
Address:__________________________________________________________________________________
City:_______________________________ State:__________________ Zip Code:_______________________
Home Phone: (_____) ______________________ Work Phone: (____) ________________________________
Age on 7/1/05: ___________ Grade (next fall): _________ Height:_________ Weight: _________
T-shirt Size (Adult): _________ E-Mail Address: _________________________________________________
Football League Team or League (2004 season): __________________________________________________
Camp fees $105.00
$50 deposit secures your ballplayer a slot at the Camp. Full payment due by July 1st2005.
Please make checks payable to Jax Youth Football League
Requested roommate or bunk mate:_____________________________________________________________
PARENTAL PERMISSION WAIVER
I herby authorize the staff of Jax Youth Football League, it’s directors, agents, doctors, athletic trainers, and hospital to act for me in accordance, with their best judgment in any emergency requiring medical attention. I herby waive and release Jax Youth Football League, it’s employees, sponsors, suppliers and facilities from any liability, for expenses incurred due to sickness or accidental injury sustained while participating in camp activities. I know of no mental or physical problems that might adversely affect my child’s ability to participate in Big South Football Camp. I have read the Big South Football Camp information and agree to the terms and conditions.
Parent’s/ Guardian’s Signature_____________________________________________Date________________
Please send Check or Money Order to:
Jax Youth Football League
PO Box 40731
Jacksonville Fl.32203
A camp packet will be sent to you upon receipt of this registration form.
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