Football Team Camp Jamboree, July 11th and 12th

(9:00-11:00 AM)
Location: Osage City High School, Osage City, KS
CAMPER/PARTICIPANT INFORMATION:
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NAME (Last)

(First)

(Middle)

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MAILING ADDRESS
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CITY

STATE

ZIP

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Campers Birthdate (MM/DD/YYYY)

Grade Level in Fall

Campers Age at time of Camp

Campers

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Parent/Guardian Name
Phone #

Parent Phone #

Alternate

____________________________________________________________________________________________

Emergency Contact

(if other than Parent/Guardian)

Relationship to Camper

Phone #

INSURANCE INFORMATION:
______________________________________________

Name of Health Insurance Provider

_________________________________________
Policy #

RELEASE
I wish to have my child participate in the Full Contact Football Camp offered by Victory Sports Camps (hereinafter referred to as
the CAMP). I hereby affirm that my child is physically able to participate in CAMP activities without restriction and that the CAMP
has been explained to me and I understand the content and structure of the CAMP.
I acknowledge that at the CAMP my child will participate in a sport that may involve, among other things, physical contact with other
persons or objects, including the ground, and that during CAMP activities, he/she is at some risk of injury.
In consideration of my son/daughter being allowed to participate in the CAMP, I hereby personally agree to assume all risks in
connection with the CAMP. I further hereby release Victory Sports Camps, its instructors, agents, representatives, officers, and
trustees from and for any injury or damage which befall my son/daughter as a result of his/her participation in the CAMP, whether
foreseen or unforeseen, and I hereby save and hold harmless Victory Sports Camps from any claim by me, my family, estate,
heirs, or assigns arising out of my childs participation in the CAMP. I further agree that I will be responsible for any medical or other
charges in connection with my childs attendance at CAMP. I understand that health insurance coverage is required for each
individual who participates in the CAMP and have written the policy information on the bottom of this form. I agree to assume all
costs related to any medical treatment that may arise out of my participation in the CAMP. I understand that I will be responsible for
any medical or other charges in connection with my attendance in the CAMP.
I further state that I am the parent or legal guardian of the participant named above and legally competent to sign this Agreement
and Release; that I understand that the terms herein are contractual and not a mere recital; that I understand that the CAMP is
voluntary and have chosen for my son/daughter to participate in the CAMP; and that I have signed this Agreement and Release as
my own free act. I have fully informed myself of the contents of this Agreement and Release by reading it before I signed it.
IN WITNESS WHEREOF, I have executed this Agreement and Release.

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Parent/Guardian Signature
Name

Date

Parent/Guardian Printed