Maple Mountain Football Team Camp Consent Form 2013
ATHLETE INFORMATION
Please Print Name _________________________________________ Age ________________
Home Address__________________________________________________________________
Home phone___________________________ Athlete’s cell_________________
Dad’s Work___________________________ Dad’s cell____________________
Mom’s Work __________________________ Mom’s cell___________________
Medical History: Please list any medical problems that we should be aware of:
___________________________________________________________________
___________________________________________________________________
In case of injury or serious illness to my son/daughter, I hereby give permission for a Physician,
Athletic trainer, coach or school employee to get medical services for my son/daughter.
WAIVER AND RELEASE OF LIABILITY FORM
I _______________________________(please print name) will be a participant at Juab High School
in the Maple Mountain Football Team Camp conducted by Coach Brad Burtenshaw, his staff, and
Juab High School staff I herby waive all claims for injury or accident of liability of any kind against
Maple Mountain High School, Juab High School, Coach Burtenshaw and any or all employees,
sponsors, coaches or members of the team participating in this camp/clinic. I am aware that I will
need to be covered by my own family insurance. I am also aware that I am in good physical shape. If
I do have any underlying medical problems or recent injuries, I will check in with the Certified
Athletic Trainers on duty and notify them of my circumstances prior to any play. All participants
must have parent’s signature.
*Requirements:
o
All participants are strongly encouraged to have a current physical
examination.
o
All participants must present a signed parent consent form
o
All participants must have a signed insurance form
o
A Student Travel form must be submitted
We have read and accept all of the above.
Parent or guardian signature:_____________________________Date__________
Important Reminders and Expectations for Team Camp
KEY CAMP INFORMATION:
 Monday, July 8th through Thursday, July 11th . We will be home about noon.
 We stay in Nephi at the Economy Lodge during camp
 We will take team buses to and from camp
o All players must ride the bus to and from camp with the team
 Bus loads at 7:15 AM, We will return to MMHS at approximately 12 PM on Thursday
 Players wear full pads at this camp - WE WILL PROVIDE THE EQUIPMENT for 10-12th
graders. The 9th grade program will provide their equipment
WHO CAN GO TO THE CAMP?
 ALL upcoming Maple Mountain Football players - grades 9 through 12
 We strongly encourage ALL players to attend - this camp is very important to our player
and team development
WHAT IS THE CAMP LIKE?
 Players work on individual fundamentals, team offense and defense, and will be
scrimmaging other teams attending the camp.
 We focus on building TEAM UNITY and CHEMISTRY and building trust and respect
between coaches and players.
 We choose this camp because of the great amount of coaching, practice, and competition
that is provided, for a very low cost (compared to other camps).
WHAT DO I NEED TO DO SO I CAN GO TO CAMP?
 Fill out and turn in THIS camp registration from.
 Pay $200 for camp, bus and fees made payable to Maple Mountain Football
o If you do not have the money, please talk to Coach Burtenshaw. NEVER let
money be the reason you miss out on this fun learning experience.
 We strongly recommend that you have a PHYSICAL that is less than 1 year old
o FREE Physicals are being offered by Canyon View Medical Group
 See Coach Burtenshaw, or the football website for more details
 Get your equipment on your designated day (Check the website)
IMPORTANT REMINDERS ABOUT CAMP:
 The camp will provide 3 breakfasts and 3 dinners for all players, as well as snacks
o Please bring money for lunch – they are on your own
 Players roommate assignments may be determined by Coach Burtenshaw with the purpose
of breaking down team barriers and building true team unity! Please be willing to get to
know new people and give them a chance!
 Players are expected to follow team and camp rules concerning dress code, language, and
behavior at all times - NO HAZING OF ANY KIND
 Players failing to follow team expectations will face consequences that could include
removal from camp and being sent home
 Players are expected to be tough and competitive and camp and to get the very most out of
the experience!
THIS PAPER IS YOUR TICKET TO GET ON THE
BUS. IT MUST BE FILLED OUT AND SIGNED!