Online Registration

First Name (required)

Last Name (required)

Email (required)

Address (required)

City (required)

State (required)

zip (required)

HomePhone (required)

WorkPhone (required)

CellPhone (required)

Imergancy Phone (required)

First Name (required)

Last Name (required)

Sex (required)

BirthDate (required)

Height (required)

Weight (required)

Grade in Fall (required)

School (required)

Tshirt Size (required)

Please note any special information we should be aware of (required)

Comments

Carrier Name (required)

Policy# (required)

Physician (required)

Phone (required)

Please list 2 other people allowed to pickup your child

Person1 (required)

Person2 (required)

On Behalf of my child(ren), I accept and assume any and all risks associate with his/her/their attendance and participation in the camp and its activities.I understand that my child(ren) should not attend the camp if he/she/they are not healthy. I understand that my child(ren) must abide by camp policies and instructions of the camp staff.I agree that should my child(ren) dismissed from camp,no part of my tuition will be refunded.I understand that no reduction in the tution will be made for late arrival,early departure, vacation,illness or injury.In the Event i cannot be contacted in an imergancy,i hearby grant DeSean Jackson`s Youth Football Camp permission to give immediate treatment and/or take my child(ren) to hospital imergancy room.Permission is hearby granted for photographs and/or videos to be taken of my child at camp and DeSean Jackson`s Youth Football Camp has the right to utilize these in Brochures,videos,sideshows,website,and any other camp materials.Permission is also granted for my child(ren) to attend all scheduled field trips.Knowing these facts and in consideration of you accepting my child(ren)'s application ,i or myself,and anyone else who might claim on my or my child(ren)'s behalf('i'),hearby agree that DeSean Jackson`s Youth Football Camp is not responsible for accidents, injuries and/or medical or dental expenses arising from my child(ren)'s participation in the camp and accordingly,i convenant not to sure and waive release and discharge DeSean Jackson`s Youth Football Camp and anyone working on their behalf from any and all claim of liability or expenses of any kind or nature whatsoever arising out of or relating to my child(ren)'s participation in the camp.I have carefully read all of the Information in this application form and agree to all conditions.

I agree