OFFICIAL USE ONLY
Registration Form
Birth Certificate
Summer 2017
Amount paid
July 12-14th
9-Noon
$
Cash
Check
First Baptist Church
1208 S Tyler St,
Amarillo, TX 79101
Other
Ck #
Player Information
Last Name
First
Address
Male
MI
City
Female
Phone:
Zip:
Birth Date
Grade going into fall 2017
Father's Last Name
First
Additional Phone
Mother's Last Name
First
Additional Phone
Email Address:
Shirt Sizes:
Youth Sizes S (6-8)
M (10-12)
L (14-16)
Adult Sizes Small
Medium
Large
XL
XXL
FEE $45-Only 100 spots available
Make checks payable to 478 Football and mail to 1600 4th Ave Canyon, TX 79015.
IMPORTANT - YOU MUST READ AND SIGN BELOW
I understand and am aware that football, as well as any other sport, is or may be a hazardous or dangerous activity. I understand that
the sport of football involves a risk of injury to any and all parts of my child's body.
I hereby agree to freely and expressly assume and accept any and all risks of injury to my child while he/she is engaging directly in the
sport of football.
I, individually and on behalf of my child, hereby release the 478 Football Camp , its successors, its agents, servants,
representatives, coaches, officers, and directors, or anyone in privity with it or them, for injuries or damages relating to the sport of
football and/or engaging in the sport of football.
Signature of Parent or Guardian:
X
Date
I hereby grant permission to the 478 Football Camp, its representatives, coaches, officers, and directors to post any picture of my child
in connection to the league's website and/or any other public function.
X
Date
As the parent or legal guardian of (child's name)
, I hereby give consent to
emergency medical care prescribed by a daily licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under
whatever conditions are necessary to preserve the life, limb or well-being of my dependent.
Signature of Parent or Guardian:
X
Date
Emergency Contact
Phone
Relation
List any medical conditions:
For more information, please visit our website at: www.478football.com
Or email questions to: [email protected]