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Chuck Wiley's Front 7 Football Combine Camp PO Box


									                 Chuck Wiley’s                                Camp Registration Form        PART I          CAMP DISCLAIMER MUST BE CHECKED IF
        Front 7 Football Combine Camp                                                                       SUBMITTING ONLINE OR SIGNED BY LEGAL
                                                                                                            GUARDIAN IF SUBMITTING BY MAIL OR FAX. I
 Superior football instruction, skill development      CAMPER’S NAME                           By
                                                                                                            AM THE PARENT OR GUARDIAN OF THE
                                                                                       checking this box
drills, SPARQ testing, official camp T–shirt, snack,                                                        NAMED CHILD WHO IS A CANIDATE TO BE A
                                                                                        you agree to the    PARTICIPANT AT CHUCK WILEY’S FRONT 7
       chalk talk with Chuck, and much more!                                           terms and condi-
                                                       CAMPER’S AGE                                         FOOTBALL COMBINE CAMP. I HEREBY GIVE
Who?                                                                                   tions of PART I of   MY APPROVAL TO THE PARTICIPATION IN ANY
Boys, ages 9-18 years old, along with coaches                                            Chuck Wiley’s      AND ALL OF THE ACTIVITIES OF THE 2009
from KRCS, Front 7, and celebrity coaches from
                                                       SCHOOL                           Front 7 Football    CAMP. INCLUDED BUT NOT LIMIITED TO
                                                                                         Combine Camp       PRACTICES, DRILLS, GAMES, TOURNAMENTS,
the National Football League.                                                                               WEIGHT TRAINING INSTRUCTIONS, IF ANY,
                                                                                           Disclaimer       AND ANY OTHER ACTIVITY ASSOCIATED
What?                                                  PARENT OR GUARDIAN                                   WITH THE CAMP ON AND AFTER THE DATE
The Front 7 Football Combine Camp is hosted by                                                              HEREOF. IN CONSIDERATION OF YOU PER-
Chuck Wiley. Athletes will compete in combine                                                               MITTING MY CHILD TO PARTICIPATE IN THE

tested drills, participate in Nike SPARQ testing &     STREET ADDRESS                                       CAMP AND THE ACTIVITIES, AND IN CONSID-
                                                                                                            ERATION OF THE TIME AND EFFORT DEVOTED
rating.                                                                                                     BY THE COACHES AND SUPERVISORS AND
                                                                                                            STAFF OF THE CAMP. I ASSUME ALL RISKS
Why?                                                   CITY/STATE/ZIP                                       AND HAZARDS THAT CAN BE INCIDENTAL TO
To stress the importance of teamwork, com-                                                                  THE CONDUCT OF THE ACTIVITIES AND
petiveness, healthy lifestyles, character, goal                                                             TRANSPORTATION TO AND FROM THE AC-
setting, education, and off-season training.           EMAIL ADDRESS
Tuesday, July 14, 2009 & Wednesday, July 15,                                                PART II         I FURTHER HEREBY RELEASE, ABSOVLE, IN-
                                                       HOME & CELL PHONE                                    DEMNIFY AND AGREE TO HOLD HARMLESS
2009; 8:00 AM to 1:00 PM                                                                                    CHUCK WILEY, FRONT 7 LLC, CHUCK WILEY’S
Where?                                                                                                      FRONT 7 FOOTBALL COMBINE CAMP, SEEDS
                                                                                       checking this box
King’s Ridge Christian School
                                                       HEALTH INSURANCE CARRIER                             OF SUCCESS, BOARD OF DIRECTORS, TRUS-
                                                                                       you agree to the     TEES, THE ORGANIZERS, DIRECTORS, SPON-
2765 Bethany Bend Rd. ,                                                                terms and condi-     SORS, SUPERVISORS, COACHES, REFEREES,
Alpharetta, GA 30004                                                                    tions of PART II    COUNSELORS, KING’S RIDGE CS, AND AD-
For more school directions and camp info, call KRCS:
                                                       POLICY NUMBER                   of Chuck Wiley’s     MINISTRATION AND EACH OF THEM, FROM
                                                                                        Front 7 Football    ANY CLAIM, DEMAND, OR ACTION ARISING
(770)754-5738 OR email:                                                                                     OUT OF, OR IN ANY WAY RELATED TO CHUCK
                                                                                        Combine Camp                                                                   Disclaimer
                                                                                                            WILEY’S FRONT 7 FOOTBALL COMBINE CAMP
                                                                                                            OR RELATED ACTIVITIES, INCLUDING, BUT
                                                       CARRIER TELEPHONE NUMBER                             NOT LIMITED TO ANY INJURY TO MY CHILD
How? Enrollment?                                                                                            EXCEPT AND ONLY TO THE EXTENT OF AND
  Enrollment will be limited to 250                                                                         IN THE AMOUNT COVERED BY ANY ACCIDENT
                                                                                                            OR LIABILITY INSURANCE. IN THE EVENT OF
   participants prior to July 14, 2009.
                                                       EMERGENY CONTACT INFORMATION                         AN INJURY, CHUCK WILEY’S FRONT 7 FOOT-
  All information must be completed for                                                                     BALL COMBINE CAMP-STAFF IS AUTHORIZED
   registration to be processed.                                                                            TO OBTAIN ANY MEDICAL CARE OR TREAT-
                                                       FIRST CHOICE (Full Name)                             MENT DEEMED NECESSARY. I HAVE CARE-
  Please turn in your complete application by                                                               FULLY READ THE ABOVE WAIVER AND RE-
  mailing it to the information below.                                                                      LEASE AND FULLY UNDERSTAND THIS IS A
                                                                                                            RELEASE OF LIABILITY AND I HAVE SIGNED
  Registration and the waiver/release must be
                                                                                                            IT VOLUNTARILY. I ALSO GIVE PERMISSION
  signed by the participants parent or legal           HOME NUMBER                                          TO   HAVE    MY   CHILD’S  IMAGE/VOICE/
  guardian prior to participation.                                                                          PHOTOGRAPH TO BE USED BY THE FRONT 7
                                                                                                            FOOTBALL COMBINE CAMP FOR PROMO-
  $70 for KRCS Students, $100 for non-KRCS             CELL NUMBER                                          TIONAL AND EDUCATIONAL PURPOSES. I
  students, No Personal Checks.                                                                             UNDERSTAND THAT THEY WILL BECOME THE
                                                                                                            PROPERTY OF CHUCK WILEY’S FRONT 7 JRS
              Chuck Wiley’s                            SECOND CHOICE (Full Name)                            FOOTBALL COMBINE CAMP.
             Front 7 Football
              Combine Camp                                                             _____________________ ___________________________
             PO Box 467004                             HOME NUMBER                     CHILD’S NAME                PARENT OR GUARDIAN SIGNATURE

            Atlanta, GA 31146                       CELL NUMBER                     ________________________
           Fax: (270)682-0459                                                          PARENT OR GUARDIAN’S NAME
CAMP UNIFORM:        Circle one: Adult
                                             In consideration of my child or minor (child) receiving the opportunity to par-
T-Shirt              S M L XL XXL            ticipate in the event or program described:

Has the participant Circle:                  1.   I attest and verify that my child is free from all illnesses, injuries or defects
had a physical      Yes or    No                  and is physically fit and sufficiently trained to participate in all activities
exam in the past 12                               associated with the program or event noted above. My child's participa-
                                                  tion in activities and events organized or sponsored by the Front 7 Pro-
months?                                           gram is voluntary.
Participant’s        Circle one:             2.   I am aware that there are risks to my child’s personal safety or property,
offensive            Line/QB/RB/TE/WR             including the risk of serious injury and/or death in conjunction with his/her
position                                          participation in activities and events. On behalf of my child, I assume all
                                                  risks associated with my child’s participation in activities and events or-
Participant’s        Circle one:                  ganized or sponsored by the Front 7 Program, including death, injuries or
                                                  illness to person and damage or loss to property.
defensive position   Line-LB/OLB/DB/
                                             3.   I do hereby, for my child, myself and any or either of our heirs, adminis-
                     Safety                       trators, executors, guardians, representatives, and next of kin, forever
                                                  WAIVE, RELEASE, DISCHARGE AND COVENANT NOT TO SUE
Your registration forms must be                   the Front 7 LLC, Chuck Wiley’s Front 7 Football Combine Camp, Chuck
completed prior to the registration               Wiley, King’s Ridge Christian School, Seeds Of Success, and/or their
deadline. You can register online at              respective representatives, officers, directors, employees, agents, volun-
                                                  teers, medical personnel and invitees (Releases) for any and all damage, Or send to:
            Chuck Wiley’s
                                                  and any claim therefore on account of injury to the person or property or
                                                  resulting in death, whether caused by the negligence of Releases or others,
                                                                                                                                       Chuck Wiley’s Front 7
           Front 7 Football
                                                  while my child is in any way engaged in or associated with activities and
                                                  events organized or sponsored by the Front 7 Program, King’s Ridge                     Football Combine
           Combine Camp                           Christian School or connected with Chuck Wiley. I further agree to in-

           PO Box 467004
                                                  demnify, defend and hold harmless Releases from damages arising from
                                                  my child’s participation or association with activities and events organized
          Atlanta, GA 31146                       and sponsored by
                                                  Releases.                                                                           King’s Ridge Christian
         Fax:(270)682-0459                   4.   I consent to administration of first aid and other medical treatment to my
                                                  child in the event of injury or illness and release and indemnify Releases
   Registration is open between
                                                  from any all liability or claims arising out of such treatment.
                                                                                                                                      Tuesday & Wednesday,
         June 12, 2009 to
           July 14, 2009
                                             5.   I hereby grant full permission to Releases as described above, to use any
                                                  photographs, videotapes, motion pictures, recordings or any other record                July 14-15, 2009
                                                  of the activities of the above named program or event for any legitimate
                                                  purpose. All photographs, resumes or other submissions taken by or given
                                                  to the Front 7 Program shall be the property of the Front7 Program.
                                                                                                                                        8:00 AM to 1:00 PM
** You are not officially registered until
         you have received a
                                             I hereby state that I am the legal guardian of the child identified below and that I
     confirmation letter email **            am authorized to make this decision. I agree to indemnify, defend and hold
                                             harmless Releases, as described above, from any loss, liability cost, claim or
                                                                                                                                             Ages 9-18
                                             damages whatsoever that may be imposed upon said Releases because of any
                                             defect in or lack of such authority to take the actions described herein on behalf
                                             of the child.
                                                                                                                                            Chuck Wiley’s
                                                                                                                                           Front 7 Football
                                             I have read and understand all of the above, and voluntarily sign this document,
                                             and further agree that no oral representations, statements or inducement apart                Combine Camp
                                             from the foregoing written agreement have been made.                                          PO Box 467004
                                             _____________________                   _________________________                            Atlanta, GA 31146
                                             CHILD’S NAME                            PARENT OR GUARDIAN’S NAME                          KRCS: (770)754-5738
                                             PARENT OR GUARDIAN SIGNATURE                      CHILD’S DATE OF BIRTH                     Fax: (270)682-0459

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