May 27, 28, 29 - 6:00 to 8:00 PM - Rollie Greeno Field - Jamestown College Campus
Player's Name
______________________________
Address___________________________________
City/State/Zip_______________________________
Phone____________________________________
Emergency #_______________________________
Grade (Fall 2007):___________________________
Shirt Size (Youth: 10/12 or 14/16, Adult: S M L XL):_____
Equipment to bring:
Tennis Shoes and/or Football Shoes (recommended but not required)
This is a non-padded, non-contact camp
I understand that Jamestown College does not provide medical insurance for its campers. Jamestown College camp directors and instructors will not be held responsible for injuries or loss of property while the above named student is attending the camp. I hereby release Jamestown College, its officers, agents and employees from any and all liability, including claims and suits in law or equity, for any injury, fatal or otherwise. I will be responsible for any medical or hospital expenses while attending the camp and authorize Jamestown College to act for me should a medical emergency arise.
________________________________________
Parent's signature (required)
Insurance Provider # _______________________
Mail registration and payment
to:
Jimmie Football
Attn: Coach Bud Etzold
6068 College Lane
Jamestown, ND 58405