2019 JACKSON FOOTBALL YOUTH CAMP REGISTRATION
Each camper must have a separate form submitted.
Camp Days: June 3rd-6th, 2019
Time: 10 am - 12 pm
Location: Robert Fife Stadium, 7355 Mudbrook St NW, Massillon, OH 44646
Contact: Coach Larry Baker (330) 327-0906 or jhsfbyouthcamp@gmail.com
Email address *
Camper First Name *
Your answer
Camper Last Name *
Your answer
Contact Name *
Your answer
Contact Phone Number *
Your answer
Grade in 2019 Fall School Year *
Please choose a shirt size (note: T-shirts are pre-ordered based off this registration form): *
Emergency Contact Name *
Your answer
Emergency Contact Relationship to Camper *
Your answer
Emergency Contact Phone *
Your answer
Dentist
Your answer
Physician
Your answer
Hospital
Your answer
This is to certify that my child (please choose from below) HAS or DOES NOT HAVE full medical insurance coverage through a family protection policy and I will assume responsibility for medical expenses that might occur during this JHS athletic event. *
Payment Type *
A copy of your responses will be emailed to the address you provided.
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