WILSON FOOTBALL CAMP 2011 REGISTRATION FORM	print  |  close window
Last Name:     First Name:
Street Address:
City:    State:    Zip:
Parent Email:   Age (as of 6/27/11):    Grade (Fall 2011):
School You Will Attend in the Fall of 2011:
Home Phone:    Alternate Phone (Cell):
Emergency Contact (Name - Please PRINT):
Emergency Contact Phone Number:
Position(s) / Please Circle:       QB      Receiver/Back    Defensive Back      Line
Shirt Size / Please Circle:     S     M     L     XL    XXL    XXXL
Any Restrictions on Participation?
My son has permission to attend Wilson Charger Champion Football Camp. Enclosed is a $40 non-refundable reservation fee (or full payment of $160.00). This will be applied to the tuition, balance of which will be paid prior to camp. In the event of illness or injury I hereby give my consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment and order injections, anethesia or surgery. I will be responsible for any medical or other charges in connection with his attendance at camp.
CANCELLATIONS:  Written or emailed cancellations must be received no later than two weeks prior to the first day of camp (Deadline: June 13, 2011), in order to receive a refund. Refunds will be mailed in full less the $40 deposit/administrative fee.
PRINT Parent's Name:   Today's Date:       Parent's Signature:       Email Address:
My Child  is Covered By (Name of Insurance Company):
Policy No.
Send Application (and Make Checks Payable) to:
John Wilson, 125 W. Reamer Ave., Wilmington, DE 19804