WOLVES & PUPS ONLY

Participating Youth Information:

First name

Child Email

Last name

Birthday

Child Phone Number

Football Position interested in/ or played in:

Parent/Guardian Contact Details:

First Name:

Last Name:

Phone Number:

Address

Youth Special Health Needs:

Emergency Contact:

Please list an additional emergency contact to the parent guardian's contact:

Emergency contact name and relationship:

Emergency Contact Phone Number:

Medical Release:

In the event of an accident or illness, I understand that reasonable effort will be made to contact the parent/guardian immediately. However, if I am not available, I authorize the Everett School district to secure emergency medical care as needed.

Name of preferred doctor:

Doctor Phone Number

Medical Insurance:

I understand that I am assuming financial responsibility for medical expenses that may arise from my childs participation and that the Everett School District requires but does not provide medical insurance for my child. I certify that my child has current medical coverage under the following plan:

Health Insurance Carrier:

Plan Insurance:

Assumption of Risk and Use of Equipment Release:

As a parent or guardian of a student planning to participate in summer activities, I hereby acknowledge that I have read, understood, and agree to do the following:

I acknowledge that the activity of JHS Youth Football Camp/Mentorship Program entails many risks of injury, even when played in an instructional clinic environment. These risks of injury include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeltal system, and serious injury or impairment to other aspects of the body, general health, and well being.

I further certify that my child has no medical or physical conditions which could interfere with his/her safety in this activity or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by and such condition.

I am fully aware of the special danagers and risks inherent in participating in on or off campus summer activities in the sport listed previously, including physical injury and/or death. I hearby waive, release, absolve, indemnify, and agree to hold harmless Everett School District employees, suppliers, sponsors, and participants for any and all liability and for any and all injuries or illness incurred while at camp. Being fully aware of the risks, I hereby give permisson for my son/daughter to participate in the activites listed above.

I agree to picture consent of my athlete to be used

I want to subscribe to JHS Booster Emails

COST IS $30

Thanks for registering!