2009 Football Camp Registration Form

Portland Youth Football League

2009 Camp Registration Form

Football Camp: June 15th - 19th, 2009 - Times - 5:30pm - 8:00pm Richland Park practice field.

Cost is $20.00 non-refundable, to be paid on or before first day of camp. Players will receive a T-shirt on the final day of camp. All players need to be dressed in T-shirt, shorts, and cleats for week of camp.

Football Team: _____6/7/8 _____9/10 _____11/12

Child’s Name:___________________________________________________ Date of Birth: _____________________

Address:___________________________________________ City, State:______________________ Zip:__________

Has child ever played football? yes or no Experience:______________________________________________

Did child attend last year’s camp? yes or no

T-shirt size: (circle one) youth or adult (circle one) Sm Med Lg XL XXL

Parent’s Name:______________________________________________ Home Phone #:____________________

Cell Phone #:_________________________________________ Work Phone #:____________________________

Emergency Contact::_____________________________________________ Home Phone #:_________________

Cell Phone #:_________________________________________ Work Phone #:____________________________

Release of Liability

I understand by the very nature of the activity, football carries a risk of potential injury. No matter how careful the player and coach are, I understand that there is a risk of injury. The risk includes minor injuries such as broken bones, dislocations and muscle pulls. The risk also includes catastrophic injuries such as permanent paralysis or even death from landing or falling on the back, head or neck. The undersigned agrees, individually and on behalf of the child, that the child, by and through the undersigned or any other person, will not institute or commence any action at law or equity for any damage of any kind that may be sustained by the child as a result of participation in the program. The undersigned further agrees, individually and on behalf of the child, to release, indemnify and hold harmless the organization, its successors, members, directors, officers, coaches, sponsors and volunteers from any claims, demands or actions at law or equity that may subsequently be brought by or on behalf of the child to recover for injuries or damages, including claims for contribution or indemnification made by third parties, arising out of injuries resulting from participation in the program.

The above player has my permission to participate in the PYFL Football Camp.

________________________________________________________________________________________________

Signature of Parent or Legal Guardian Date