2019 Little Diamondbacks Football Camp Registration
2019 Junior Diamondbacks Football Camp
Camp Dates: July 23-25
Location: Century HS Main Field
Cost: $40 (before May 25)
$50 (after May 25)
Who: 3rd-8th Graders
Pre-register by submitting this form and payment made to Century Football to 7801 W. Diamondback Dr., Pocatello, ID 83204, or register at camp.
Coached by Century coaching staff and Varsity football players. All campers receive t-shirt, three days of instruction and camp awards.
First and Last Name
2019-2020 Grade Level
Adult X Large
Adult XX Large
Known medical conditions (please list)
CONSENT & RELEASE FORM PERMISSION TO PARTICIPATE My child, named below, has permission to participate in the Century High School Youth Football Camp. My child is in good health and has no medical restrictions limiting physical activity. NOTE: While your child is in the care of a coach, an emergency may occur which requires immediate medical or dental attention. Your authorized consent, as the child’s parent or guardian, in advance of such treatment serves to protect you, Century High School, the coaches and the doctor, by assuring that prompt emergency treatment can be administered. This form enables you to provide this consent as well as to offer information helpful in the treatment of your child. There may be no physician or other health related professional on site during these camps. CONSENT TO TREATMENT OF A MINOR The undersigned parent or guardian of the minor child named below hereby authorizes the coach, or such substitute as he or she may designate as agent for the undersigned, to consent to any transportation, X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to the said minor under the general or special supervision and upon the advice of any physician or surgeon licensed under the provisions of the Medical Practice Act and to consent to any X-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provisions of the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, in the hospital or otherwise. This authorization is given prior to any diagnosis or treatment known to be required in order to enable said coach or agents to act effectively in an emergency situation when I cannot be contacted. Should said coach or agents exercise their authorized consent there under upon the advice of a licensed physician or surgeon or dentist, I knowingly and voluntarily discharge and hold harmless said coach or agents of the football camp and workouts from any liability for this action. I understand that all reasonable measures will be taken to safeguard the health and safety of my child and I will be notified as soon as possible in case of an emergency. The authorization shall remain effective the duration of the football camp and summer workouts.
I do not agree
Never submit passwords through Google Forms.
This form was created inside of Pocatello-Chubbuck School District 25.
Terms of Service