Request edit access
2019 Penncrest Lions Youth Football Clinic In Conjunction with Media's Famous Dining Under the Stars....... One Media........ One Pride
Join us on Two Wednesday’s this Summer, June 26 and July 10 to learn the game of football and have fun while doing it. This summer the Brand New Lions football staff and team are offering an evening camp for second through eighth graders. This is Mom and Dad’s opportunity to enjoy an adult meal while your children are cared for and safe at Penncrest’s very own Louis W. Stadium (Turf Field). Campers will develop football skills including passing, catching, punting, kicking, tackling, blocking etc. and will participate in various football games. No equipment will be needed. The camp will run from 6PM-8PM. Parents may drop off as early as 5:30PM at the Louis W. Scott Stadium with a cost of $40 (Family discount $30) per session or $60 for both (Family discount $45). Registration can be completed using this document. Registration can also be completed at the event beginning at 5:30PM. Please visit us online at
www.penncrestfootball.com.
Dining Under the Stars Reservations
Make your reservation today at one of Media's Participating Restaurants
Restaurant Choices
Camper Registration Information
Name *
Your answer
School Camper Attends *
Camper Address *
Your answer
Phone Numbers *
Your answer
Email *
Your answer
Age of Camper *
Your answer
Camper Emergency Contact Information
Name of Contact *
Your answer
Phone Number *
Your answer
Parent Release
To: Penncrest Football Gridiron Club We, (or I), hereby request that you accept the application of ____________________________________ in the Penncrest Lions Football Camp during the dates set forth in this application, and in consideration of your acceptance of the application, we will (or I)(whether one or more) hereby release Rose Tree Media School District, for the use and benefit of Penncrest Football, and all its employees from all claims on account of any injuries which may be sustained by our (or my) minor son/daughter as a result of any such injuries. If medical attention is required for injury or illness while in camp, I give my permission for such medical care. We also grant permission for the Penncrest Lions Football Camp to use photographs of our son/daughter for publicity, advertising or other social media purposes. This school admits all qualified applicants without regard to race, color, religion, or national origin. Signed (Parent)
Camper Name *
Your answer
Parent Signature (Initials) *
Your answer
Date *
MM
/
DD
/
YYYY
Medical Certification
To: Penncrest Lions Football Camp I hereby certify that ___________________________________ is physically fit to participate in an active football school and that I know of no physical impairments which would in any manner limit his participation in such a program.
Camper Name *
Your answer
Parent Signature (Initials) *
Your answer
Date *
MM
/
DD
/
YYYY
Campers Must Have Medical Insurance
Insurance Company *
Your answer
Policy Number *
Your answer
What days will you attend? *
Required
Dietary restrictions *
T-Shirt Size
Online Payment or Pay Upon Arrival *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy