Video Library About Us Services Events Photo Gallery Prospects Recruiting Info Home
|
Video Library About Us Services Events Photo Gallery Prospects Recruiting Info Home
|
|
REGISTRATION FORM
REGISTRATION FORM / WAIVER
Name: _______________________________________________ Nick Name ______________________ LAST NAME , First Name
Date of Birth: _______________________ AGE ________ Year Graduated High School: ___________ MM/DD/YEAR
High School Positions: _____________________________ _________________________ ________________ Offense Defense Special Teams Height: _____________ Weight: _______________ GPA _______________ SAT ___________ ACT ______
High School : ____________________________ Head Coach : _____________________ School Address: __________________________ Coaches Phone Number: (_______) ___________________
Your Home Address: _____________________________________ City : ______________________ Zip: ______ I understand that there is an inherent risk of injury with my participation in the football combine, and that this injury may lead to permanent disability or death. In the event of routine of emergency health examinations diagnostic procedures, treatment of illness, and/or injuries, permission is herby granted to treat the athlete above by the emergency medical staff, physicians associated with other community facilities as needed. The Student-athlete is cleared for all full contact physical activities (football related activities). We the undersigned, as a Participant in and the parents or legal guardians of a Participant in the Program, hereby waive and renounce any claims against the camp coordinators and all Entities participating in the Program, including without limitation any claims based on negligence, for any injury to the Participant or others, loss damage, sickness, accident, delay, or expenses of any kind whatsoever resulting from the Participant’s participation in the Program/Camp.
Your Signature: _____________________Date ______ Parents Signature: __________________Date ________ Phone Number : ( ) _______________________ Parents Cell ( ) ______________________
Camps You will Attend: June 22-23 TUE & WED. Football Camp Youth ____ or High School ______ (check one) Cost $ 40.00 in advance and $ 50.00 on site registration. Bernstein High School 1309 West Wilton Place Hollywood, CA 90028 (Near W. Sunset Blvd. and the 110 FWY.)
July 10 SATURDAY Football Camp Youth ____ or High School ______ (check one) Saddleback College 1 DAY CAMP The Registration fee $ 40.00 in advance or $ 50.00 day of the event.
July 17 SATURDAY Football Camp Youth ____ or High School ______ (check one) Cost $ 30.00 in advance and $ 40.00 on site registration. Los Alamitos High School 3591 Cerritos Ave Los Alamitos, CA 90720 (Off 605 FWY at Exit 2B -Spring/Cerritos Exit)
Print and Mail Payment to:
eSportsInstruction P.O. Box 15602 Los Angeles CA 90015
Include Payment with entry for each camp. Payable to eSportsInstruction.com
|