North Dakota State University
Parent’s or Guardian’s Participation Agreement
of Waiver of Liability, Indemnification,
and Medical Release
To be signed by adults if participant is under 18 years of age.
Acknowledgment and Assumption of Risk
The undersigned parent and/or legal guardian does hereby acknowledge
that he/she is aware of the dangers and the risks to the participant’s
person and property involved in participating in Bison Football Camps.
The undersigned parent and/or legal guardian and participant understand that this activity involves certain risks for physical injury to the
participant. We also understand that there are potential risks of which
may presently be unknown. Because of the dangers of participating
in this activity, the undersigned parent and/or legal guardian and
participant recognize the importance and the participant agrees to
fully comply with the applicable laws, policies, rules and regulations,
and any supervisor’s instructions regarding participation in this activity.
The undersigned parent and/or legal guardian and participant
understand that the State of North Dakota (State) does not insure
participants in the above-described activity, that any coverage would
be through personal insurance, and the State has no responsibility
or liability for injury resulting from this activity.
NDSU Bison
Football
Youth Camps
The undersigned parent and/or legal guardian acknowledges
that the participant voluntarily elects to participate in this
activity with knowledge of the danger involved, and hereby
agrees to accept and assume any and all risks of property
damage, personal injury, or death.
Waiver of Liability and Indemnification:
In consideration for being allowed to voluntarily participate in the
above-referenced event, on behalf of myself, the participant, his/her
personal representatives, heirs, next of kin, successors and assigns,
the undersigned parent and/or legal guardian forever:
a. waives, releases, and discharges the State of North Dakota
and its agencies, officers, and employees from any and all liability for
the participant’s death, disability, personal injury, property damages,
property theft or claims of any nature which may hereafter accrue
to the participant, and the participant’s estate as a direct or indirect
result of participation in the activity or event; and
b. defend, indemnify, and hold harmless the State of North
Dakota, its agencies, officers and employees, from and against any
and all claims of any nature including all costs, expenses and attorneys’
fees, which in any manner result from participant’s actions during this
activity or event.
READ BEFORE SIGNING
Name of Camper_________________________ Age of Camper _____
Printed Name of Parent/Guardian ______________________________
Signature of
Parent/Guardian_______________________________ Date _______
(To be retained by originating department)
Bison Football Camp
NDSU Dept 1220
PO Box 6050
Fargo ND 58108-6050
I, the undersigned parent and/or legal guardian, affirm that I am
freely signing this agreement. I have read this form and fully
understand that by signing this form I am giving up legal
rights and/or remedies which may otherwise be available to myself,
the minor participant regarding any losses the participant may sustain
as a result of participation in the activity. I agree that if any portion is
held invalid, the remainder will continue in full legal force and effect.
Camp applications due June 9, 2017
Consent is given for the participant to receive medical treatment,
which may be deemed advisable in the event of injury, accident or
illness during this activity or event. This release, indemnification, and
waiver shall be construed broadly to provide a release, indemnification,
and waiver to the maximum extent permissible under applicable law.
Tuesday- Wednesday-Thursday
June 13-15, 2017
Grades 1-4 7:30-11:00 a.m.
Grades 5-8 1:00-4:30 p.m.
North Dakota State University
Fargo, N.D.
Bison Youth Football
Camps Daily Schedule
Dear Campers and Parents,
Grades 1-4 • Mornings only
Please print clearly
7:30-8 a.m.
Registration/Arrival
Camper Name_______________________________________
8-8:30 a.m.
Camp warm up
We are very excited about the NDSU Bison Youth
Football Camps. Each camper will be coached by
our entire football staff as well as current Bison
players. Emphasis for grades 1-4 will be on the
FUNdamentals of football. For grades 5-8, we
will focus more on position specific development
and football knowledge. Come and join Bison
players and coaches for a great three-day camp!
Go Bison!
Chris Klieman
Head Football Coach
Camp Information
•Camp is located at the outdoor grass practice
fields (1500 University Dr N) south of the SHAC.
•Parking will be in the R and RF lot west of the
grass practice fields.
•A camp T-shirt will be provided to each camper
on the first day and should be worn each day.
•Beverage bottles will be provided by
Gate City Bank at the conclusion of camp.
•Campers need to wear shorts and tennis shoes.
•No helmets or shoulder pads.
•Campers will be broken up into groups and teams
based on age.
•Certified trainers will attend all practices.
•A snack and beverage will be provided each day.
•Water will be available at all times.
•Sun block and bug repellant will not be provided.
•Cost of camp is $100 per camper (which includes
a $50 non-refundable deposit).
•Register online at www.ndsufootballcamps.com
OR mail in completed registration form with your
full payment. No walk ups or registration day of
camp. Registration confirmation will be sent to
you via email.
Questions?
Tyler Roehl
Atif Austin
Margie Trickle
[email protected]
[email protected]
[email protected] or 701.231.7816
8:30-9:30 a.m. Offensive and Defensive
practices
9:30-10 a.m.
Snack/water
10-11 a.m.
Football activities
•Razzle Dazzle
•Agility tests
•7-on-7 passing
•1-on-1 passing
•Football position competitions
✃
Message from
Coach Chris Klieman
CAMP APPLICATION
Complete both sides or
register online at www.ndsufootballcamps.com
Address____________________________________________
City_______________________________________________
State _________ Zip Code____________________
Telephone ( )_______________________________
Parent E-mail________________________________________
Confirmation will be sent by email.
Grades 5-8 • Afternoons only
Insurance Company___________________________________
This camp will focus more on position specific
training geared toward this age group and
will prepare you for the upcoming season.
Policy Number_______________________________________
1-1:30 p.m.
Registration/Arrival
Emergency Contact Information (Name, Phone)
1:30-2 p.m.
Camp warm up
__________________________________________________
2-3 p.m.
Offensive and Defensive
position specific skill
training
3-3:30 p.m.
Snack/water
3:30-4:30 p.m. Football activities
•Razzle Dazzle
•Agility tests
•7-on-7 passing
•1-on-1 passing
•Football position competitions
NDSU is required to provide reasonable accommodations
for guests with disabilities. Examples of accommodations
include a sign language interpreter, a dietary accommodation,
or a wheel-chair accessible room. In the event there are
additional expenses involved, it is the responsibility of
the sponsor to pay. Guests are required to contact the
sponsor a minimum of 3 weeks before the event.
NDSU does not discriminate in its programs and activities on the basis of age, color, gender
expression/identity, genetic information, marital status, national origin, participation in lawful
off-campus activity, physical or mental disability, pregnancy, public assistance status,
race, religion, sex, sexual orientation, spousal relationship to current employee, or veteran
status, as applicable. Direct inquiries to Vice Provost for Title IX/ADA Coordinator, Old Main
201, NDSU Main Campus, 701-231-7708, ndsu.eoaa.ndsu.edu. This publication will be made
available in alternative formats for people with disabilities upon request, 701-231-7881.
School_____________________________________________
Age ____________
Ht. ____________ Wt. ____________
GRADE (in Fall of 2017) ____________
Check one offensive position
❑ QB ❑ RB ❑ WR ❑ TE ❑ OL
AND check one defensive position
❑ LB ❑ DB ❑ DL
Register online or mail $100
payment and application to:
Bison Youth Football Camp
NDSU Dept 1220
PO Box 6050
Fargo ND 58108-6050
fee
$50
This des a
able
u
incl refund
non sit
o
dep
Camp applications due June 9, 2017