Dickinson Area Youth Football Camp

Registration Form

Player Registration Information

Name: _____________________________________

Date of Birth ____-____-_____

Address: ___________________________________

City:  ______________  Sate:_______  Zip: ________

Grade you will be entering: ______________________

 

Parental Consent

Authorization:  I consider the football camp registrant to be in good health, and permission is granted to participate in all camp activities, unless otherwise indicated on this form.  In case of illness/injury, permission is granted for medical treatment to be rendered to my child.  I understand that I will be notified in case of serious illness.  All medical bills incurred by my child will be my responsibility.

Parent/Guardian Name: __________________________________________________________

Parent Signature: _______________________________________________________________

Phone: _____-_____-_____

Work: _____-_____-_____

Cell: _____-_____-_____

Home: _____-_____-_____

Known allergies: _____________________________________________________________

Health Insurance Carrier: ______________________________________________________

Policy Number: ______________________________________________________________

 

T-Shirt Size: (check one)

Youth: 10-12 ___  14-16 ____

Adult:  S ____     M ____  L ____     XL  ____

 

Offensive/Defensive Positions:

(If you know them)

___________/____________

 

 Mail Registration by June 30th

 or (preferably) deliver to:

Norway High School

C/o Football Camp

300 Section St.

Norway, MI 49870