NFA GOLDBACKS FOOTBALL CAMP
HTTPS://TINYURL.COM/NFAFOOTBALL 
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Have you read our Flyer? *
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Have you Read Our Information Form? *
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Athlete Name? *
AGE? *
Grade? *
School? *
Grade Level Next Upcoming Year? *
Address? *
Parent/Guardian Names? *
Parent Cell Phone? *
Parent Email? *
MEDICAL INFORMATION
Allergies and Dietary Restrictions Please list, describe reaction and management of the reaction if applicable
Medications Please list all medications (including over the counter or non-prescription) taken regularly.  Please inform the clinic director if your child needs assistance with the storage of daily medication.
Do you understand?
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DO YOU TAKE ANY MEDICATION? *
IF YOU TAKE MEDICATION HOW MUCH AND WHAT TIME? *
WHATS THE REASON FOR TAKING MEDICINE? *
DOCTORS NAME? *
DOCTORS PHONE NUMBER? *
Permission to Secure Treatment in the event of any emergency, I Authorize the Camp Staff to secure from any licensed hospital, physician and/or medical personnel any and all treatment deemed necessary for my child’s immediate care and agree that I will be responsible for payment of any and all medical information contained in this form.  I understand that this authorization includes transporting my child by ambulance if necessary to the nearest medical treatment facility or hospital.

Parents By typing your name below you authorize your permission to secure treatment
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WAIVER RELEASE OF LIABILITY
I RECOGNIZE AND ACKNOWLEDGE THAT THERE ARE CERTAIN RISKS OF PHYSICAL INJURY TO PARTICIPANTS AND I AGREE TO ASSUME THE FULL RISK OF ANY INJURIES, DAMAGES OR LOSS REGARDLESS OF SEVERITY WHICH MY CHILD MAY SUSTAIN AS A RESULT OF PARTICIPATING IN ANY AND ALL ACTIVITIES CONNECTED WITH THE PROGRAM.
I AGREE TO WAIVE AND RELINQUISH ALL CURRENT AND UNKNOWN FUTURE CLAIMS MY CHILD MAY HAVE AGAINST NECSD AND THEIR EMPLOYEES AND VOLUNTEERS FROM ANY AND ALL CLAIMS FROM INJURY, DAMAGE, OR LOSS ARISING FROM THE ACTIVITIES OF THE PROGRAM.

I FURTHER AGREE TO INDEMNIFY AND DEFEND THE NECSD AND ITS’ EMPLOYEES AND VOLUNTEERS AGAINST, AND HOLD THEM HARMLESS FROM, ANY AND ALL CLAIMS RESULTING FROM INJURIES, DAMAGES, AND LOSSES SUSTAINED BY MY CHILD ARISING OUT OF, CONNECTED WITH, OR IN ANY WAY ASSOCIATED WITH THE ACTIVITIES OF THE PROGRAM.

I give permission for my child’s picture to be used in advertisements of NFA GOLDBACKS FOOTBALL CAMP.
I HAVE READ AND FULLY UNDERSTAND THE ABOVE RELEASE OF LIABILITY AND PHOTOGRAPHY RELEASE
WAIVER AND PHOTOGRAPHY RELEASE:

Parents By Typing your name Below you agree to Release Liability 
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