check it out! - merrimack mudcats

Transcription

check it out! - merrimack mudcats
SPONSORS
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FL P
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ST
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PR
CHECK IT OUT!
2012
• All campers will receive a
Nike water bottle.
RIMA
MER
h
t
u
o
Y
• Each camper will receive
a camp specific t-shirt,
and a personal autograph
session.
OS!
-22
21
JULY
mer
ts@
udca
ckm
rima
.com
ail
hotm
t
www.e
PO Box 508 • Tilton, NH 03276
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ballclu
sfoot
dcat
ckmu
ima
/merr
.com
eamz
S
CAT
UD
CK M
P erseverance
R espect
I ntegrity
D etermination
E xcellence
tbal
2 Foo
3
Rt. 1
lton,
d, Ti
l Fiel
NH
CAMPER
PLEASE PRINT
FIRST NAME
ADDRESS
LE
DU
CHE
TION
A
M
R
ECT
EXP
U
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g
T CA
A
ordin
WHA THIS C
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MB
8:30
Time
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Free
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9am
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1pm
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PM B
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pm:
ion.
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- 5pm
22
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T
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89 p
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4pm
July
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,
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COS r camper - $ me immediat 0th, 2012. pers to th rs getting mo
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p
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Sund 9am: Warm out Session
om s
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camp
$99
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P
INFO
CAM
July
1-22
2
ISIT:
ON V
I
MAT
FOR
E IN
F
OR
OR M
om
mz.c
.etea
www
t
udca
ackm
rim
/mer
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lub O
ballc
sfoot
a
errim
il m
Ema
LAST NAME
STATE
ZIP CODE
AGE
BIRTH DATE
SCHOOL
GRADE
KNOWN ALLERGIES OR MEDICAL CONDITIONS
T-SHIRT SIZE (ADULT)
 S  M  L  XL  XXL
POSITION
(Very Important — Check 4 Sessions of Interest)
 Running Back
 Offensive Lineman
 Wide Receiver/Tight End
 Defensive Back
 Linebacker
 Defensive Lineman
You will be assigned to a comperable age group.
PARENT/GUARDIAN INFORMATION
FATHER
PHONE
MOTHER
PHONE
EMERGENCY CONTACT
HEALTH INSURANCE CARRIER
POLICY #
PARENTAL PERMISSION
I/We, hereby agree to allow our child/children to participate in
the 2012 Merrimack Mudcats PRIDE Youth Football Camp.
In case of emergency, I understand that every attempt will
be made to contact me/us. If contact is unsuccessful, I give
permission to the attending training staff to render treatment
to my child/children, including hospitalization. Any expense
arising from injury is the responsibility of the person(s) signing
below. I hereby authorize the medical personnel to provide
care that include regular diagnostic procedures and medical
treatment as necessary to my minor son/daughter.
I agree to hold harmless the staff of the Merrimack Mudcats,
the Instructors, their agents and volunteers associated with
the camp, from any liability in connection with these activities.
SIGNATURE
DATE