DEEP FORK VALLEY YOUTH FOOTBALL CAMP OPEN TO
WHEN: JULY 16th, 17th and 19th
COST: $65.00 which includes a t-shirt $50.00 early-bird which includes a t-Shirt(Before 6/23)
TIME: 6:30 P.M. TO 8:30 P.M.
WHERE: Jensen Field-Choctaw High School
14300 N.E. 10th Street, Choctaw, OK
CAMP WILL BE COACHED BY LOCAL HIGH SCHOOL COACHES!
For more information, please call: Mike Kiesel (405)476-6624 or Ty Norton (405)206-4511
Size of T-Shirt: YS YM YL YXL AS AM AL AXL AXXL
Child’s Name: _______________________________ Age: _______________
Mother & Father’s Names: ________________________________________
Home & Cell Numbers: ___________________________________________
Emergency Contact & Number: _____________________________________
Email Address: ___________________________________________________
I understand that there is no insurance carried by the coaches and volunteers and I specifically waive and release the coaches and volunteers
from liability for any claim or financial responsibility for damages that my child might sustain due to injury/illness at the camp. I authorize the
staff to act for me and to obtain whatever medical treatment that the staff sees necessary. I further agree to be responsible for any medical of
other charges in conjunction with my child’s participation at the camp.
CHILD’S NAME: __________________________________________________
PARENT’S SIGNATURE:_______________________________ DATE:_________
Paid by:________________________________ Amount $_________________