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					         CLINTON ARROW FOOTBALL
             DAY CAMP for BOYS
                                      Ages 6 – 13




  A Non-Contact Football Camp - staffed by Clinton High School Football Coaches and Players

      Dates:        Monday, June 14 – Friday, June 17
      Place:        Clinton High School Practice Fields (behind the gym)
      Time:         8am – 11:00am
                    *working parents – staff will be present from 7:30am – 11:30
       Cost:        $75.00 (this includes camp t-shirt and daily snacks)
       Items Needed: Clothes to play in, Cleats (or tennis shoes) and
                                         Sun screen (if needed)
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              Send this application with your check (payable to “Arrow TD Club”) to:
                                          Arrow TD Club
                                         c/o Scott Brown
                                         401 Arrow Drive
                                        Clinton, MS 39056
                  Or Bring this application and camp fee to registration at the
                 CHS Arrow Field on Monday, June 14 from 7:30am – 8:30am

Name of
Camper________________________________________________________________________
Home Address_______________________________ City______________
Zip_____________________
Telephone: (Home)_____________________ (Work)____________________
(Other)________________
Age_________ Grade/School________________ T-Shirt Size (Youth)________________

Name of Parent/Guardian______________________________________________________
Name of Person Transporting Child After Camp____________________________________
Medical Insurance Co._________________________________________________________


         Please complete Consent Form on Back
In consideration of the camp fee being given the privilege of my child participating in the Clinton Arrow Football Day Camp for Boys, I, the
undersigned, hereby agree to release and discharge the Clinton Public School District, the Board of Trustees and the Superintendent of the
Clinton Public School District, Clinton High School, all employees, agents and staff of the Clinton Public School District, Coach Scott Brown,
and all persons connected with the Clinton Arrow Football Day Camp, on behalf of myself, my child, my heirs, assigns, personal representative
and estate as follows:



PARENT/GUARDIAN RELEASE AND ASSUMPTION OF RISK, STATEMENT, & CONSENT FORM
The undersigned parent/guardian certifies that my child is physically fit to participate in this non-contact football day camp. I, the undersigned
parent/guardian understand that the camper will engage in physical activity during the program that contains inherent risk and by signing this
form, I, the parent or guardian, do hereby release, forever discharge and agree to defend, hold harmless, and indemnify the Clinton Public
                                                                                                                                                   Initial
School District, the Board of Trustees and the Superintendent of the Clinton Public School District, Clinton High School, all employees, agents
and staff of the Clinton Public School District, Coach Scott Brown, and all persons connected with the Clinton Arrow Football Day Camp
(collectively referred to as the “CPSD Football Camp”) from any and all negligence claims, liability claims, demands, actions or rights of
action, or medical claims that my child or I might incur or which are related to, arise out of, or are in any way connected with my child’s
participation in this activity, including those allegedly attributable to the negligent acts or omissions of the CPSD Football Camp while in
attendance at said camp. I expressly agree and promise to assume all of the risks existing in the CPSD Football Camp.                              _____

While this is a non-contact camp, and while the camp will follow Clinton High School Football Team hydration policies (hydration before start
of the day’s exercises, water at-will and hydration every 15 minutes), the camp will be conducted outdoors and the negligence claims, liability
claims, demands, actions or rights of action, and medical claims being released, and the risks being assumed, include without limitation those
arising from exposure to and exercise and exertion in heat, humidity and the elements (such as heat exhaustion, heat stroke, heart attack, injury,
aggravation of known or unknown medical conditions, death, emotional distress, damage to property, or damage to third parties, injuries due to
over-exertion, and muscle strain), joint and bone injuries or injuries from being unintentionally struck with a football. I understand that the
CPSD Football Camp will not be attended by medical personnel.                                                                                      _____

I certify that I have for my child, and will maintain at all times while my child is participating in the activities, active health, accident and
liability insurance to cover any bodily injury or property damage that my child may suffer while participating in these activities, or else I agree
to bear the costs of such injury or damage myself. Should the CPSD Football Camp, or anyone acting on its behalf, incur attorneys ’ fees and
costs to enforce this agreement, I agree to indemnify and reimburse them for such fees and costs. The CPSD Football Camp, Coach Brown and
his staff have my permission to seek medical attention for my child should the need arise, and I agree to indemnify and hold harmless the
CPSD Football Camp for any costs to treat my child, even if a representative or agent of the CPSD Football Camp has signed hospital
documentation promising to pay for the treatment.
                                                                                                                                                    _____

By signing this document, I agree and acknowledge that if anyone (including myself and my child) is hurt or property is damaged
during my child’s participation in this activity, I will have no right to make a claim or file a lawsuit against the CPSD Football Camp
(as defined herein), its agents, sponsors, participants, directors, employees, or any other person or entity acting in any capacity on_____
behalf of the CPSD Football Camp, even if they or any of them negligently caused such injury or damage. My child’s participation is
purely voluntary.

My signature below indicates that I have had sufficient opportunity to read this document, that I have read it, that I understand it, that I _____
understand it affects my legal rights, and that I agree to be bound by its terms.

NOTICE: THIS IS A LEGAL DOCUMENT. BY SIGNING YOU WAIVE CERTAIN LEGAL RIGHTS. PLEASE READ
CAREFULLY. IF YOU HAVE ANY QUESTIONS ABOUT THIS AGREEMENT, PLEASE CONSULT AN ATTORNEY BEFORE _____
YOU SIGN IT.



 PARENT OR GUARDIAN’S SIGNATURE__________________________________________________ DATE_____________

 Drivers License or ID # _________________________________

				
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