Online Registration for Youth Football Camp Serving Delaware, Maryland and Pennsylvania

BEFORE you register for 2012 Camp, please:

CLICK TO DOWNLOAD &/OR PRINT the 2012 CONSENT FORM (PDF)

This form MUST be completed, signed and turned in the first day of camp.

ONLINE REGISTRATION
Complete the registration form below and click "Submit Registration". You will be directed to a payment page where you can pay online through PayPal, a trusted online payment processor. If you're registering multiple campers, click the "BACK" button on the Payment page to complete registration info for the additional campers. Click for additional information about PayPal.

PLEASE NOTE: Your registration will not be considered complete until we've received the deposit or full payment. ALL items below are required.

PLEASE COMPLETE A SEPARATE FORM FOR EACH CHILD.



Camper's Last Name, First Name:

Street Address:

City:

State:

Zip:

Parent Email:


Age (as of 6/25/12):		Grade (Fall 2013):

School You Will Attend in the Fall of 2013:

Home Phone:

Alternate Phone (Cell):

Emergency Contact (Full Name):

Emergency Contact Phone Number:

Position(s) / Please Check:

Receiver/Back

Defensive Back

Line

Shirt Size / Please Select:

Any Restrictions on Participation? (If so, please list)

My child has permission to attend Wilson Charger Champion Football Camp. I understand that upon submitting this form I will be directed to PayPal, where I will be paying the $45 non-refundable reservation fee (or full payment of $165.00). 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, anesthesia 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 11, 2012), in order to receive a refund. Refunds will be mailed in full less the $45 deposit/administrative fee.

Please indicate that you agree to the above statements by typing your name below as a Signature Acknowledgement:

Today's Date:

Parent's Name:

My Child is Covered By (Name of Insurance Company):

Form Validation: Please identify the image below by selecting it from the pulldown menu:

Upon receipt you will be mailed player confirmation along with emergency phone numbers and other important details.

Visit "General Information" and "Instruction" for additional info about our upcoming 2012 Camp!

NEXT Football Camp:

JUNE 25 - 29, 2012