Player Name and age: ___________________________________________________T Shirt Size:  Youth M L  Adult S M L XL

Address/City, State: _______________________________________________________________________________________________

Parent/Guardian Name: ____________________________________________________________________________________________

Home Phone/Cell Phone/Work: ______________________________________________________________________________________

Emergency Contact info: ___________________________________________________________________________________________

Phone number: ___________________________________________________________________________________________________

Medical Insurance Name: __________________________________________________________________________________________

Policy Number: ______________________________________________________

 

I give my permission for_________________________ (name of child) to participate in the football youth camp sponsored by Western Albemarle High School on July 14-16, 2014. I am aware that with participation in this camp, comes the risk of injury to my child.

 I also understand that any participant in this camp should be covered by appropriate health insurance provided by the parent/guardian and I am aware that Western Albemarle High School does not provide health insurance coverage for this event. Finally, I am aware that participants should be of good health and I verify that the child listed above does not have any existing medical condition or is taking any medication that would result in a health risk while participation in this camp.

Parent Signature: ______________________Date: _____________________

 

Cost: $125.00 per player, includes lunch and Tshirt.  Siblings discount: 2 players $210.00.

 

Register online or mail Registration form and check to :

WAFA Youth Camp 5941 Rockfish Gap Turnpike

Crozet VA 22932

 

Questions?  contact us:

westernfootballyouthcamp@gmail.com

 

 

Register for Youth Camp CANCELLED  refunds will be issued