C OLON L . H ALL S TADIUM
Chesapeake Sheriff ’s Office
Youth Football Camp 2014
c/o Chesapeake Sheriff ’s Office, Charities Inc.
401 Albemarle Dr.
C HESAPEAKE, VA 2 3 32 2
Chesapeake, VA 23322
2 5 0 M T. P LEASANT R D.
* FREE CAMP *
For more information call:
Contact Doug Whitmore
Phone: 757-382-2818
Fax: 757-382-8392
[email protected]
www.jimosullivan.org
Place
Postage
Here
* FREE CAMP *
* FREE CAMP *
For more information call
For Further Information Visit us at:
757-382-2818
www.ctltyouth.com
Chesapeake Sheriff’s
Office
Youth Football Camp
2014
“I appreciate Coach
Harris partnering with
the Chesapeake Sheriff’s
Office Youth Football
Camp 2014. We are excited to bring NFL players to teach the funda-
Jim O’Sullivan
Sheriff
This camp will enrich everyone that attends. Thank you for your support”.
Our goal for this camp is to develop excellent football
and life skills.
Frederick Douglas
Several Chesapeake High School coaches and
their assistants, college coaches as well as
current and former NFL players!
build strong children than to re-
Football
camp for Chesapeake
Middle School children ages 10—14 to
learn fundamental football skills.
Address ______________________________________________________________
and defense drills from some
of the area’s best football coaches and
players.
Phone ________________________________________________________________
Emergency Information – Please Print
Offense
Name ________________________________
Phone (
) _________________________
Name ________________________________
Celebrity athletes
and mentors share
success stories and advice.
Thursday
9:00 AM — 3:00 PM
Friday
9:00 AM — 3:00 PM
Saturday
9:00 AM — 1:00 PM
Participants need to bring shorts and cleats.
Beverages and Lunch will be provided.
Coach Elisha “Cadillac” Harris
Please Print
Student’s Name ________________________________________________________
______________________________________________________________________
Registration Extended! Sign up by June 13th to
get a football camp t-shirt. Walk-ons accepted if
space is available.
said " It's easier to
adults."
REGISTRATION
mental football skills
and to share success stories and advice.
pair broken
The Volunteer coaching staff includes:
Phone (
) _________________________
I am the parent or legal guardian for the child on this registration form, and grant
permission for the volunteer staff of the Youth Football Camp to act on my behalf
for my child in granting permission for evaluation and treatment or minor medical
problems. I understand that should a major medical problem arise, reasonable
attempts will be made to reach me by telephone at the number (s) I have listed. If I
cannot be reached, I hereby give my consent to such medical treatment as deemed
necessary by a certified Athletic Trainer, Emergency Medical Technician (EMT)
and/or a licensed physician. I understand that the Chesapeake Sheriff’s Office
Charities, Inc., a 501(c)(3)charitable foundation, does not provide any accident
and medical insurance and that I will be financially responsible for any and all
medical expenses related to injuries sustained during the camp. I have actual
knowledge of the inherent dangers, risks and injuries involved in football, a contact
sport. In addition, I, for myself, my child, my heirs, and personal representatives,
hereby waive, release, and discharge forever any and all claims of damages for
bodily injury, death, or damage or loss of property in any way related to my child’s
participation in this camp, that I or my child may have or that may accrue subsequently to me or to my child against any and all departments or divisions of the
Chesapeake Sheriff’s Office Charities, Inc., the City of Chesapeake, the Commonwealth of Virginia, Chesapeake Public Schools and all employees and agents of
such entities.The information contained herein is distributed by the Chesapeake
Public Schools as a public service. The Chesapeake Public Schools does not
endorse any agency related to the information contained herein, nor is any agency/program related to the information contained herein, sponsored by or in
connection with the Chesapeake Public Schools.
Further, I hereby give to the Chesapeake Sheriff’s Office Charities Inc. and its agents, permission to
use my child’s image/photograph/name/voice for promotional and educational purposes on behalf
of the football camp (including but not limited to brochures, booklets, videotapes, reports, press
releases, websites and exhibits).
Proof of age is required (Birth certificate, military ID, passport, certified school
records or insurance policy).
I have read, or have had read to me, this general permission and
waiver of claims statement. I understand and voluntarily agree to its provisions.
Parent/Guardian Signature_______________________________
Parent/Guardian print name______________________________