Who: 8-11th Grade Where: Phoenix H.S. Stadium

When: June 27th-30th Time: 5:30-7:30

$30 to register (T-shirt included in fee)

Register by June 10th

Make Checks payable to: Coach Chad Rowe (Cash is accepted also)

Register by mailing payment to:

Chad Rowe, Phoenix High School

552 Main St. Phoenix, NY 13135

For more information contact: crowe@phoenixcsd.org

(315)- 380-5269

This acknowledges that I, the parent or legal guardian of ______________________________, recognize the potentially hazardous nature

of youth sports and that an injury or damage might be sustained at the Firebird Football Camp 2016 (“Summer Camp”) or any Summer

Camp-related event. In the event of such an injury to my child where we cannot be contacted, we give permission for the Summer Camp

coordinator to call a medical professional to render such treatment as would be normal and agree to pay usual charges for such treatment.

I agree on behalf of myself (and my spouse, partner, all of my children, personal representatives, heirs, executors agents and assigns) to re-

lease and indemnify the Phoenix Central School District, Phoenix Football the Summer Camp, their employees, their agents, their volun-

teers, and any owned, loaned or leased facilities and the owners thereof from liability, damage or cost for any damages or personal injuries

caused by or resulting from my child participating in the Summer Camp or Summer Camp-related events. I understand that this release ap-

plies to any present or future injuries.

I further certify that to my knowledge there is no medical reason why my child cannot safely participate in the Summer Camp and that my

child agrees to abide by all rules and regulations of the Phoenix Central School District, the Summer Camp, and any facilities the Summer

Camp may use.

I acknowledge that I have carefully read this waiver and release and fully understand that it is an assumption of risk, release of lia-

bility and indemnity agreement. I am aware and agree that by executing this waiver and release, I am giving up my right to bring a

legal action or assert a claim against the Phoenix Central School District, Phoenix Football, the Summer Camp, their employees,

their agents, their volunteers, and any owned, loaned or leased facilities and the owners thereof for negligence, or for any defective

product on their premises. I have read and voluntarily sign this waiver and release and further agree that no oral representations,

statements, or inducement apart from the foregoing written agreement has been made. I agree for myself, my spouse, partner, chil-

dren, successors, heirs and assigns that the above representations are contractually binding.

Parent/Guardian Name:______________________________________ Date:_______________

Parent/Guardian Signature: _______________________________________________________

Home Address:__________________________________________________________________

E-Mail:____________________________________________________________

Home Phone #: _____________________ Cell Phone # :______________________________

Family Physician:________________________ Physician Contact Number:_________________

Emergency Contact Name &Number:______________________________

Insurance Company:_______________________ Name on Policy:________________________

Policy Number: _________________________________________

Medical conditions (allergies, medications, chronic illness, or other health issues):

___________________________________________________________________

Registration Fee: $30 (Includes camp t-shirt) T-shirt Size:___________________

Registration Due: June 10th

Checks or Cash payable to: Coach Chad Rowe

Send to: Attn: Chad Rowe

Phoenix High School

552 Main St, Phoenix, NY 13135