Lavelle Hawkins and Lynell Hamiltons Do Yurrr Thing Football Camp 2013

When:
June 29, 2013 9:00am - 4:00pm Check-In: 8am

Whos Invited:
Boys Ages 7-17

Space is limited to 500

1st 250 Boys ages 7-15 1st 250 Boys ages 13-17 so register EARLY!!! Mail OR Fax Registration Form & Waiver Fax: 209-846-9309 Mail: Freeman 2601 Oakdale Road, Suite Q Modesto, CA 95355

Where:
Edison High School Football Field 1425 S Center St Stockton, CA

Come on June 29th wearing workout attire, tennis shoes or cleats (no pads). Registration Form

due by June 7, 2013 via Mail or Fax. You will be contacted via email or mail to confirm
your attendance. MUST be pre-registered, NO walk ups accepted!! NO EXCEPTIONS!!
Childs name:_________________________________________________________________________ Age and Position:_______________________________________________________________________ Address:______________________________________________________________________________ Phone Number:________________________________________________________________________ Email Address:_________________________________________________________________________ Emergency Contact Name & Number :______________________________________________________ Allergies:_____________________________________________________________________________ Current Medication:____________________________________________________________________ Pertinent Medical History:_______________________________________________________________ Family Doctor:_________________________________________________________________________ Phone: (____)__________________________________________________________________________ Insurance Co.:_________________________________________________________________________ Policy Holder:__________________________________________________________________________ Policy Number:________________________________________________________________________ T-Shirt Size:___________________________________________________________________________

Incomplete applications will NOT be accepted!!!!!

Questions or concerns, please contact Jeneya at (209)541-7080 or via email at jeneyafreemanpromo@gmail.com

Participants Name: _____________________________________________________________________________ Lavelle Hawkins and Lynell Hamiltons Do Yurrr Thing Football Camp 2013 June 29, 2013 Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Waiver: In consideration for being permitted to participate in any way in Lavelle Hawkins and Lynell Hamiltons, Do Yurrr Th ing Football Camp 2013, I, for myself, my heirs, personal representatives and assigns (including, but not limited to the participant in the camp listed on the application) (collectively Releasing Parties), do hereby release, waive, discharge and covenant not to sue Lavelle Hawkins and Lynell Hamiltons Do Yurrr Thing Football camp 2013, its owners and their respective partners, owners, officers, employees, directors, contractors, assigns and agents (collectively Lavelle Hawkins and Lynell Hamiltons Do Yurrr Thing Football camp from and for any and al l claims, liabilities, cost, fees, action and causes of action of every nature, character and description, known and unknown, including, but not limited to, all those arising out of or in any way related to the negligence of Lavelle Hawkins and Lynell Hamiltons Do Yurrr Thing Football camp, any individuals presence at the camp (as a participant or otherwise), any personal injury, any accidents or illnesses (including death), and or any property loss (collectively, the Claims). Releasing parties expressly waive the Provisions of section 1542 of the California Civil Code, which provides that A general release does not extend to claims which the creditor does nor know or suspect or exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor. The signatory below represents and warrants that he or she owns and/or has the authority to release the Claims released herein and to bind each of the Releasing Parties as provided in this Waiver of Liability Assumption of Risk and Indemnity Agreement, that none of the Claims have been assigned or transferred, and that this document contains the entire agreement of the parties. _____________________________________________________________________________________________________________________ Signature of Parent of Minor (on behalf of all Releasing Parties) Date Assumption of Risk: Participation in Lavelle Hawkins and Lynell Hamiltons, Do Yurrr Thing Football Camp 2013 carries with it certain inherent risk that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to a nother and from one individual to another, but the risk include, but are not limited to 1) minor injuries such as scratches, bruises and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks and concussions and/or 3) catastrophic injuries including paralysis and death. Releasing parties acknowledge that they have read the previous paragraphs and know, understand, and appreciate these and other risks that are inherent in The Lavelle Hawkins and Lynell Hamiltons, Do Yurrr Thing Football Camp 2013. Releasing Parties hereby asser t that their participation is voluntary and Releasing Parties expressly agree that they knowingly assume all such risks. Indemnification and Hold Harmless: Releasing Parties also agree to DEFEND, INDEMNIFY AND HOLD HARMLESS Lavelle Hawkins and Ly nell Hamiltons, Do Yurrr Thing Football Camp 2013 from and aga inst any and all claims, actions, causes of action suits, procedures, costs, expenses, damages and liabilities, including attorneys fees , that arise out of or are in any way related to the camp or any of the Re leasing Parties participation in or presence at Lavelle Hawkins and Lynell Hamiltons, Do Yurrr Thing Football Camp 2013. Releasing Parties further expressly agree that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, co ntinue in full legal force and effect. Acknowledgement and understanding: Releasing Parties acknowledge and expressly agree that they have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that they are giving up substantial r ights, including rights to sue. Releasing Parties acknowledge that they are signing the agreement freely and voluntarily, and intend the signature below to be a completed and unconditional release of all liability to the greatest extent allowed by law. _____________________________________________________________________________________________________________________ Signature of Parent of Minor (on behalf of all Releasing Parties) Date RELEASE AUTHORIZATION FOR EMERGENCY TREATMENT I understand that I am required to maintain and carry accident medical insurance coverage for the child listed on this application and I verify that the coverage information in the application is accurate and true. In the case of an emergency and if I cannot be reached, I authorize the staff of Lavelle Hawkins and Lynell Hamiltons, Do Yurrr Thing Football Camp 20 13 to obtain whatever medical treatment he/she deems necessary for the welfare of my child listed on this application. I further understand that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether or not my medical insurance would cover such charges and fees. I am the parent/guardian of the minor ___________________________________________________________ and I am signing this Release on behalf of said minor. _____________________________________________________________________________________________________________________ Parent/Guardian Signature Date