Campers Name (required)

Address (required)

Phone Number (required)

Email Address (required)

Age, Date of Birth, Grade, High School Attending (required)

Height, Weight, Position, Adult Shirt Size (required)

Emergency Name and Contact Number (required)
[heightweightposition]

Parent Signature (required) *This will be consider a electronic signature*

***Parents Please Bring Insurance Card on 1st day of Camp***

*Participants do not need physicals in order to participate*

Parent consent acknowledgement and release form (a) i/we hereby give consent for my son to participate in the 2010 gridiron institute football camp. (b) I/we know of and acknowledge that my son knows the risks involved in participation in such a camp and understand That serious injury and even death is possible in such participation and choose to accept any and all responsibility for his safety and welfare while participating. With full understanding of the risks involved. I/we release and hold harmless my school, the schools involved, gridiron institute football camp, gridiron institute llc, any coach or professional player and trainer, as well as anyone involved in the administration of this camp of any and all responsibility and liability for any injury or damage resulting from participation and agree to take no legal action against any of the above because of any accidents or mishap's involving the participation of my son.

Media Release
I authorize Gridiron Institute Football Camp to videotape and photograph my child’s, image and/or voice for use in program materials, program marketing materials and the program website. I understand and agree that these audio, video, film and/or print images may be edited, duplicated, distributed, reproduced, reformatted, and/or translated into other languages in any manner without payment of fees, in perpetuity.

I have read this carefully and know it contains a release.
I accept the terms

Insurance Information (required) *Include: Insurance Policy, Policy Number, and Date*

Parent/Guardian Signature (required) *This will be consider a electronic signature*