Utica College 2009 High School by t9839202


									Important: Medical Authorization

                                                           2009 Utica College Pioneers HS Team Football Camp
In an emergency, I hereby give permission for
my child______________________ to be                                                                                                     Utica College
examined by the campus trainer. I also give permis-
to the camp operator to hospitalize, secure proper
treatment, anesthesia, or surgery for my child in an
I also give the camp permission to advise the hospi-
                                                                                                                                         High School
of our insurance information at the time of treatment.
                                                                                                                                         Team Football
Our Health Company is:                                                                                                                      Camp
Contract Group #:
Disclaimer of Liability:
         The UC Football staff & HFC Blaise
Faggiano do not assume liability for any injuries in-                                                                                    Monday July 13th-
curred while at the camp or on the way to the camp.
         As a condition of enrollment, the following                                                                                     Thursday July 16th
disclaimer of liability must be signed and dated by
the campers parents: The camper in attending the                                                                                          6:00pm - 9:00pm
UC Youth Football Camp, and in using Utica College
does so at their own risk.                                                                                                              @ Charles A. Gaetano
         The UC Football Staff, HFC Blaise
Faggiano, Utica College their athletic departments,                                                                                            Stadium
and staff, shall not be liable for any damages arising
from personnel injury sustained by the camper dur-                                                                                          Utica College
ing the camp or at the facilities.
         The camper and his/her parents assume full
responsibilities for any damages or injuries that may
occur to the camper during the clinic session and so
hereby fully and forever exonerate and discharge the
UC Football Staff, HFC Blaise Faggiano, Utica Col-
lege, their athletic departments, and staff from any
and all claims, demands,
damages, rights of action causes of action, present
                                                                                                               Utica College Football

                                                                                                               1600 Burrstone Road

or future whether the same be known, anticipated, or
                                                                                                               Clark Athletic Center

resulting from or arising out of the campers
                                                                                                               Utica, NY 13502

participation in the camp and the use of the facilities.

Signature of Parent/Guardian:
Signature of Camper:
                                                             DAILY SCHEDULE:
                                                               6:10—Run & Stretch                        Registration Form (front & back)
       Camp Philosophy:                                     6:20—Individual (Offense)
   The camp is designed to provide a                         6:50—Interior / Skeleton                   Name________________________
   contact football experience for high                            7:05—Team                            ____
  school athletes in the Mohawk Valley                      7:20—Individual (Defense)
                                                             7:50—Interior / Skeleton                   Age_____ T-Shirt Size______
area. Teams and individuals are encour-                            8:05—Team                            Grade/Fall 09 _____
 aged to attend. All high school coaches                        8:20—Post Stretch                       Ad-
  who have athletes attending the camp                      8:25—Thought for the day
are invited to assist. High school coaches                 Schedule subject to change.
 will have the opportunity to run their of-                                                             _
fense & defense during interior, skeleton,    CAMP DIRECTOR:                                            City__________________________
             and team periods.                Blaise Faggiano                                           ___
                                              Head Football Coach, Utica College                        State___________
     Questions Please Contact:                EQUIPEMENT/REQUIRMENTS:                                   E-mail________________________
            Blaise Faggiano                   The camp will be conducted in "uppers." Campers           School Dis-
                                              must supply their own helmets, chin straps, shoulder
    Head Football Coach Utica College         pads, practice jerseys and mouth pieces. It is also       trict_____________________
             Camp Director                    recommended that campers bring molded or screw-
         bvfaggiano@utica.edu                 in cleats for the playing surfaces. Check all equip-      Coach's
             315-792-3713                     ment prior to entering camp. Please write your last
                                              name on some athletic tape and place it on                Name____________________
                                              the front of your helmet. This will help our coaching     Coach's Phone
                                              staff tremendously. Thanks, Coach Faggiano
                                                                                                        Parent or Guardian
                                              Charles A. Gaetano Stadium                                _______________
                                              All-purpose playing surface, and grass fields.            Home
                                              FEES:                                                     Work
                                              Enclose $75 fee with the application. The fee in-
                                              cludes a camp T-shirt. You will receive an email re-
                                              sponse confirming registration prior to camp.             Cell Phone
                                              Make Checks Payable to: “Utica College Football.”         _______________________

                                              INSTRUCTION:                                                    Pre-register by June 20th.
                                              Instruction will be provided by the Utica College foot-       Please Return Form To:
                                              ball staff and high school coaches from the
                                              Mohawk Valley.                                               Utica College Football Office
                                                                                                               Clark Athletic Center

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