rhare breed training camp registration form 3

RHARE BREED TRAINING FOOTBALL CAMP REGISTRATION FORM

UPLAND HIGH SCHOOL FEB 25 10AM-1PM

7402 Morris St. Ph. (951)977-9300 Riverside, CA 92503 Fax. (951)977-9301

ATHLETE'S INFORMATION Name: Birthday:

Last First Middle Initial (mm/dd/yyyy)

Email address: CONTACT INFORMATION Address: Cell Phone:

CA Home Phone:

City State Zip code EMERGENCY CONTACT INFORMATION SCHOOL/ CLUB INFORMATION

Parent Name: Ph.

School/Club Name:

Relation: Grade:

Parent Name:

Ph. Position:

Relation:

MEDICAL CONDITIONS Please list any conditions that may be a concern to participate in this sport, include any medications:

*** CONSENT FOR EMERGENCY TREATMENT AND RELEASE OF LIABILITY*** I understand that there are always risks involved in sports activities. I acknowledge these risks and declare my child physically able to participate in the Rhare Breed Training program. In the event of a medical emergency, I authorize any Rhare Breed Training representative to obtain emergency treatment for my child, (if my emergency contact cannot be reached). I understand the costs of medical treatment are my responsibility and that a relative of the player must be at the hospital to assure proper medical treatment. I agree to abide by the rules and regulations, as may be established by Rhare Breed Training. I, intending to be legally bound, do waive and release all rights, claims, demands, and/or causes of action against Rhare Breed Training, its partners, associates, and sponsors for any personal injuries suffered which may occur, now or in the future, arising from or out of my participation with Rhare Breed Training. I acknowledge that all videos, photographs and/or likeness taken by Rhare Breed Training, its owners, officers, employees, successors, assignors and anyone acting under the authority or permission thereof, to make and copyright photographs and video ("Photographs and "video" as used herein include any reproductions of my likeness, voice, name and/or image) can and will be used and distributed for promotional purposes.

Insurance Provider:

ID#:

REGISTRATION COSTS Registration fee: $25 *Cash, Money order

or Major Credit Card

IGA Approval Signature

Parent/Guardian Name (Print) Parent/Guardian Signature Date

RHARE BREED TRAINING FOOTBALL CAMP REGISTRATION FORM

UPLAND HIGH SCHOOL FEB 25 10AM-1PM

7402 Morris St. Ph. (951)977-9300 Riverside, CA 92503 Fax. (951)977-9301