An application must be filled out for each player attending the camp.

All applications must be accompanied by a check made out to:

Big Men Only Football Camp, LLC

All applications must be mailed to:

Big Men Only Football Camp, LLC
P.O. Box #1814
Shavertown, PA 18708

Siblings: Please send applications in the same envelope.

Personal Information

Name ______________________________________

Age: ________ Height: ______ Weight: _______

Address: __________________________________________________________

City: __________________ State: ___ Zip Code: _________

Home Phone: (_____) _____________ Parents Work Phone: (_____) _____________

E-mail:____________________________________________________________

High School: ____________________________________________________

Grade in September 2010: _______

Amount Enclosed: __________

Release

I, _______________________________________________________________,

the Parent/Legal Guardian of _________________________________________,

in consideration of my child being permitted to participate in the football camp described herein, do, for myself, my child and our respective heirs, executors, administrators and assigns, hereby release and forever discharge Big Men Only Football Camp, LLC, its members, owners, sponsors, coaches and participants, their heirs, administrators, executors, successors and assigns, of and from any and every claim, demand, action or right of action, or whatever kind of nature, either at law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from or occur as a result of my child’s participation in the football camp described herein. I acknowledge that football is an inherently dangerous activity. I further release those parties set forth herein from any claim whatsoever on account of first aid, treatment or service rendered to my child during his participation in the football camp described herein. I have carefully read the releases contained in this paragraph and understand the contents thereof.

Parental Medical Authorization

I request and authorize the Athletic Training Staff of the Big Men Only “BMO” Football Camp, LLC and local hospitals, medical personnel, agents, and employees to provide reasonably necessary medical care including, but not limited to, medical transport, hospital tests, such as pathology, radiology, anesthesia, surgery, and prescription drugs advisable for the health of my child.
I acknowledge that no representations, warranties, guarantees as to results or cures will be made. The name of the child covered by this authorization is:

Minor’s Name: ______________________________

Medical Insurance Policy No.:__________________

Medical Conditions: __________________________

___________________________________________

Current Medications: _________________________

Allergies: __________________________________

Should hospitalization and/or the care of a physician be required, the camper must rely on his/her medical insurance plan for payment of all medical services rendered.

Emergency Contact

Name: ____________________________________

Day/Work Phone: ___________________________

Home Phone: _______________________________

Cell Phone: ________________________________

Parental Consent – I hereby grant permission for my child to attend the Big Men Only Football Camp, LLC and for any photographs taken to be used for future camp brochures, and I hereby reaffirm the release provisions and consents contained herein.

___________________________________________________________________
Signature of Parent/Legal Guardian Date