MOC-FV YOUTHFOOTBALL CAMP

Tuesday, August 9, 2016

For students entering Grades 5-6

6:00 PM – 8:00 PM

CAMP INFORMATION:

We would like to invite you to participate in the MOC-FV Football Camp for students entering Grades 5 & 6. This camp is designed to promote the game of football while creating an opportunity for the 2016 MOC-FV High School football team and coaching staff to serve the youth of our area. Emphasis will be placed on football fundamentals, teamwork, sportsmanship, and FUN!

LOCATION:

MOC-FV High School Practice Field
(behind the baseball/softball fields)

COST

$20 per athlete

Please make checks payable to

MOC-FV Football. Each participant will receive a t-shirt for attending.

EQUIPMENT

Please make sure your child has tennis shoes/cleats, t-shirt, and athletic shorts.

REGISTRATION FORM

Please complete and detach the form. Send form and payment to:

Grant Hegstad

210 5th St. NW

Orange City, IA 51041

* Please complete registration by July 15 *

Additional forms located on MOC-FV Homepage and on MOC-FV Football Facebook page.

* Walk-ups are welcome to register the evening of August 8. T-shirts sizes only guaranteed with pre-registration *

Questions?

Call or email Coach Hegstad using the information below:

(712) 348-5241

Athlete Name: ______

Address:______

______

Phone:______

Grade Entering in Fall 2016:

5th______

6th______

Please circle t-shirt size:

Youth:SML

Adult:SML

Release of Liability and Medical and Surgical Authorization

In consideration of the 2016 MOCFV Football Camp, granting the student permission to participate in the 2016 MOCFV Football Camp, I herebyassume all risks of his or her personal injury (including death) that mayresult from any 2016 MOCFV Football Camp activity. As guardian I dohereby release the 2016 MOCFV Football Camp and their officers, agents,and all instructors and all participants in said Football Camp from allliability, including claims and suits of law or in equity, for injury, fatal,or otherwise, which may result from the student taking part in FootballCamp activities. In addition, I hereby authorize and give my consent to any licensedhealth professional to perform upon or administer any reasonable,necessary surgical or medical treatment. I also give permission toadminister whatever anesthetic may be necessary or advisable duringthe medical or surgical procedures. This authorization is intended tocover emergency treatment, immunizations, injections, and minoroperations and procedures. I agree to assume all costs related to suchtreatment. I acknowledge that my child is physically able to participatein football camp activities without restriction. I know of no medical orphysical problems which would affect my child’s ability to participate.

Parent/Guardian Signature: ______

Phone: ______Date: ______

If Parent/Guardian cannot be reached, contact:

Name: ______

Phone: ______