The Town of Clay Recreation Department Sponsors

Liverpool Warrior Football Camp

July 6th through July 10th, 2015

Director:David Mancuso – Varsity Football Coach

Location:Liverpool HS Stadium

Session I:Boys in grades 4th, 5th, 6th, 7th, 8th – 9:00 to 11:30 AM

Session II:Boys in grades 9th, 10th, 11th, 12th – 12:30 to 3:30 PM

Dates:July 6th to July 10th, 2015, Monday through Friday

What to

Bring:cleats, shorts, t-shirt, water bottle

Fees:$60.00 (includes camp t-shirt and athletic trainer on site)

Registration:Any of the following are acceptable:

THERE IS NO DEADLINE DATE FOR REGRISTRATIONS!

Mail in registration, send form to -David Mancuso, Town of Clay Football Camp, Liverpool High School, 4338 Wetzel Rd, Liverpool, NY 13090.

Register at the Town of Clay Recreation Office - 4401 Route 31, Clay, NY, 13041

On line registration – go to

*Make checks payable to: Town of Clay Football Camp, you may pick up a registration form at the

Town of Clay Recreation Dept., 4401 Route 31, Clay, NY 13041

*If you have any questions, please contact David C. Mancuso at 383-3447 or 453-1500 ext. 4215

Please detach Bottom portion and mail with check or money order to the address above.

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Town of Clay Recreation and Human Resource – Youth permission Wavier

I understand participation in the TOWN OF CLAY FOOTBALL CAMP involves rigorous physical activity and risks of physical injury, and we assume these risks. I hereby give consent for emergency transportation and treatment in the event of illness or injury. I hereby accept responsibility for the payment of any emergency transportation or treatment on behalf of the participant. I further certify the participant is in good physical condition, and has no medical or physical conditions that would restrict his/ her participation in this event.

(Parent/Guardian signature)______on this date:______, 2015 does hereby covenant and agree to release and hold harmless the Town of Clay from and against all liability, loss, damages, claims, or actions (including costs and attorney fees) for bodily injury and /or property damage, to the extent permissible by law arising from our participation in the TOWN OF CLAY BOY’S FOOTBALL CAMP during: July 6th through July10, 2015. There is no medical insurance carried by the Town of Clay for program participants. Pictures and other materials, which include my child, may be used for the town of Clay promotional purposes. REFUNDS IN FULL MAY BE GIVEN ONLY 48 HOURS IN ADVANCE OF PROGRAM START.

Participant Name: ______Date of Birth: ______

Grade in fall: ______Height: ______Weight: ______School in fall: ______

Address: ______City:______ZIP: ______

Home Phone #: ______Work #: ______Cell#: ______

Medical/ Allergy History: ______

Name of Insurance Carrier: ______ID#: ______

email: ______

T-shirt size – please circle: S M L XL XXL XXXL (adult sizes)

Please Check which session you will be attending: Session I (Gr.5-8):______Session II(Gr.9-12): ______

Check / Money order #: ______Cash Receipt: ______Amount: ______