"Final Call" Feb 4, 2012.

Football Showcase Application

In cooperation with the

Mims in Motion, Sports Scholarship USA ,PrepStar 2012 All Star Game,

Plays and Grades, and FootballConsultant.net

High School Registration begins at 8am

9-11 Showcase

Jr. College  Registration begins at 8 am

9-11 Showcase

email confirmation to : eplaybook1@mindspring.com

Bring Signed Waiver Form to the event.

 Please Print Clearly

Name___________________________________________

Street Address____________________________________ Apt#______________

City________________________________     State__________  Zip______________

Home Phone (          )______________ Cell Phone (        )_______________

Email______________________________       Facebook_______________________

School______________________________________           Grade_________________ Date of Birth ___________

Height___________            Weight___________           T-shirt Size__________

Offensive Position__________      Defensive Position__________

Parent/Guardian Name__________________________________________

Contact Number _____________________ email___________________________

Alternate Emergency Contact

(Name)_________________ (phone#)_________________

 Camp Contacts: Coach Grant (Phone) 323 503 5675

(Email) eplaybook1@mindspring.com

                                             CAMP SCHEDULE

8:00am…Registration Begins

          9:00am…Camp Begins

12:10pm…Camp Concludes

Waiver

I, as parent/legal guardian of ______________________________ , hereby release, indemnify & hold harmless eSportsInstruction.com, Sports Scholarship USA, El Camino Real Charter High School , hosting school, any and all volunteers, instructors, supervisors &  staff members & their assigns , licensees, successors-in-interest, legal representatives, employees &heirs from any liability claims, causes of action, damages or cost or expense arising out of or relating to any and all injury that may result to my child while participating in the event whether or not such injury is caused by the negligence or fault of the parties being released.

I agree to instruct my child to cooperate & conform with the directions and instructions of the instructors or any supervisor in charge of the event and all policies and procedures relating to all activities. Furthermore, I understand and agree that my child is expected to comply with The Alliance Code of Conduct at all times during the event.

Should it be necessary for my child to have medical treatment while participating in this event, I hereby give the supervisory personnel permission to use their judgment in obtaining medical services for my child and I give permission to the physician selected by such personnel to provide medical treatment deemed necessary and appropriate by such physician(s).

I warrant and represent that my child is under no medical condition and is not taking any medication, which would limit their ability to engage in any activities.

I warrant and represent that I am under no disability, restriction or prohibition, either contractually or otherwise, with respect to my right to execute this waiver.

I have read the release and fully understand its contents.

Print Name of Parent/Legal Guardian                                                       Phone Number

Signature of Parent/ Legal Guardian                                                         Date

Alternative Emergency Contact Person                                                    Phone Number