7th Annual Youth Football & Cheerleading Camp Registration

Your Name (required)

Your Email (required)

Athlete Information

Athlete's Last Name

Athlete's First Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Emergency Contact

Emergency Phone

Relation to Athlete

Athlete's Date of Birth

Current Grade

School Team

Offensive Position:

Defensive Position:

Height (Feet and Inches)

Weight (Pounds)

T-Shirt Size (All Adult Sizes)
Select SizeSMLXL2X

Medical Information

Does the athlete have any of the following? Drug Allergies, Special Dietary Needs, Asthma, Allergies to Insect Bites, Food Allergies, Other Allergies, Frequent Headaches, Dizziness or Seizures?
NoYes

If Yes, Please explain

Is the athlete taking any medication?
NoYes

Please explain (dose and frequency)

Is there any other health history or medical information regarding the Athlete that DCYFC, or any person supervising the Athlete at the camp should be aware of?

CAMP WAIVER

THIS IS A LEGAL AND BINDING AGREEMENT. UNDER THIS AGREEMENT, YOU ARE ASKED TO WAIVE (GIVE UP) CERTAIN RIGHTS YOU MAY HAVE INCASE OF ANY INJURY THAT YOU (Parent/ Guardian) CAN NOT SUE THE FOOTBALL CAMP OR THE FOUNDATION FOR ANY REASON. IF YOU SIGN THIS AGREEMENT YOU GIVE UP ALL OF THOSE RIGHTS. DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ IT FULLY AND UNDERSTAND IT COMPLETELY.

GENERAL RELEASE & WAIVER For good and valuable consideration, the sufficiency of which I hereby acknowledge, I, personally and on behalf of the above named athlete as the parent and/or legal guardian, and anyone acting on my behalf, including but not limited to attorneys, representatives, agents, heirs, executors, administrators, assigns, insurers, predecessors, successors or any other person or entity asserting claims through me, agree to release, indemnify, defend and hold harmless: The David Clowney Foundation and all of their respective directors, officers, shareholders, subsidiaries, partners, agents, sponsors, employees, successors, parents, beneficiaries, heirs, executors, administrators,
assigns and affiliates thereof (collectively, "Releasees"), from and against any and all claims, suits, losses, damages, expenses, costs, and liabilities (including reasonable attorneys' fees and expenses) which hereinafter may accrue or arise against the “Releasees” and which in any way arise out of or are in anyway related to (a) my child's participation in The David Clowney Youth Football Camp and/or (b) the use of my child's name, photograph, quotation, and likeness in any advertising or promotions which relate to the camp. As the parent and or legal guardian of the athlete, I hereby grant permission for him to participate in the above camp at the Delray Beach Soccer Complex and represent that he is physically able to participate in camp activities. In consideration of the athlete being allowed to participate in the camp, I thereby release the camp, the Foundation, its employees, officers and affiliates from all claims resulting from illness, injuries or any other damages which may be sustained by the child during attendance at the camp. I furthermore agree and promise that we will not hold the Foundation or any of the above mentioned parties responsible in this respect. This waiver of liability expressly includes transportation to, from, or in connection with said camp. In the event of illness or injury, I hereby authorize the staff members of the camp to obtain assistance from doctors, nurses or athletic trainers for medical, surgical or any other appropriate treatment for the above mentioned child. Furthermore, I grant permission and consent for the attending physician to provide any medical or surgical treatment, which, in the physician’s professional opinion, is deemed to be necessary. If medical/surgical care is obtained, we will not hold the camp or City of Delray, its employees or affiliates responsible or liable for the judgment of and/or treatment by the physician. I understand that the camp director (David Clowney IV), City of Delray, and the National Football League cannot assume responsibility for medical, dental or other health expenses incurred or issues/injuries sustained as a result of my child’s attendance at camp.

Filling in the signature below and submitting this form constitutes a legally binding signature.

Parent / Guardian Signature

Date: