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Name ______________________________________________________________________________________ q Male q FemaleAddress ___________________________ City ____________________ Zip_________ Phone Number (_______)_______________E-mail Address _____________________________________________ Current School ____________________________________ Grade ________ Age _______ T-Shirt size (circle one): XS S M L XL XXL
EMERGENCY CONTACT INFORMATIONParents Name ______________________________________________ Emergency #______________________________________Medical Insurance Carrier _____________________________________ Policy # __________________________________________Other emergency contact _____________________________________ Phone # _________________________________________Please list any medical conditions, limitations, or needs: _________________________________________________________________________________________________________________________________________________________________________
I hereby authorize the director, staff, and volunteers of the Hit & Hustle Football Camp to act for me according to their best judgement in any emergency medical situation. I hereby waive, release, exonerate, and discharge the Archdiocese of Los Angeles, Bishop Amat High School, and the Hit & Hustle Football Camp Staff and all its volunters from any and all actions or causes known or unkown, from any injuries incurred in camp, or on the way to and/or from camp. Costs for treatment of injuries and hospitalization for illness or injuries incurred during the Hit & Hustle Football Camp will be the responsibility of the parent or guardian of the participant. I certify that my child is healthy, and has no injury or illness which would limit his participation.
Parent Signature ___________________________________________ Date __________________
Please complete registration form, enclose $75 check, detach and mail to:
Hit & Hustle Football Campc/
o Steve Hagerty
2820 Rhodelia Ave | Claremont, Ca 91711
Make checks payable to: Hit & Hustle Football Camp
$75Registration fee includes
Bishop Amat High School
Camp DirectorSteve HagertyHead Football Coach, Bishop Amat High School
The football coaching staff, along with varsity players at Bishop Amat High School will be instructing at the camp
What to Bring...// T-shirt & Shorts// Cleats & Athletic Shoes// Water Bottle (Optional)
Contact phone: 626-962-2495 ext. 6001 or [email protected]
Grades 3-8
Part I: Friday, 6/22/12 6pm-9pmPart II: Saturday, 6/23/12 9am-12pm
The Hit & Hustle Football Camp is a basic skills camp put on by the Bishop Amat football coaching staff, and is happening on Friday and Saturday, June 22 -23, 2012. On Friday the 22nd, the camp begins at 6 pm and dismisses at 9 pm. On Saturday the 23rd, the camp resumes at 9 am and concludes at 12 pm. The cost of the camp is $75 and includes six hours of instruction, hot dog lunch, group photo, certificate of participation, camp t-shirt, and two tickets to a football game for the 2012 season. If interested, contact Coach Hagerty at 626-962-2495, ext. 6001, or [email protected].