2010 Football Camp Brochure

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					                                                                                                                   PARENTAL CONSENT: Before medical operations and procedures can be performed on minors, the law requires parental permission. As
                                      APPLICATION                                                                  parent or guardian you are asked to sign the following consent form that will allow medical procedures to be carried out promptly and without
                                                                                                                   unnecessary delay. Except in emergencies, no medical operations will be performed without the parent or guardian being contacted and
                                                                                                                   informed of the situation.

Name:____________________________________________________________                                                  As the minor’s parent or guardian, I have actual knowledge and appreciate that there are risks of bodily injury, such as cuts, sprains,
                                                                                                                   concussions, and broken bones from one’s participation in football camp activities, and hereby voluntarily consent to the minor’s participation
                                                                                                                   in football camp activities and assume all risks of possible injury.
                                                                                                                   Signature _______________________________________________________________________ Relationship __________________________
City:_______________________________ State:__________ Zip:______________
                                                                                                                   RELEASE & WAIVERS OF CLAIMS: In consideration of my child/dependent being permitted to attend and participate in football camp
                                                                                                                   activities, I, for myself, my child/dependent, my heirs, and personal representatives, do hereby waive, release, and discharge forever any and
Home Phone: ______ - __________________ Camper Cell: ________________                                              all claims for damages for bodily injury or death or damage or loss of property, that I or my child/dependent may have or that may occur
                                                                                                                   subsequent to me or to my child/dependent against the camp operators, its officers, employees, agents, volunteers, representatives; and in
                                                                                                                   consideration of the camp being offered at it premises, and The Board of Trustees of The University of Alabama and its trustees, officers,
Age:______ Grade: (Fall 2010)______ Email: _____________________________                                           employees, and agents (the “University”) arising from or attributable to my child/dependent’s attendance at and participation in football camp
                                                                                                                   activities. Further, I hereby give to the University and its agents and representatives permission and a release to use as necessary my
School Attending (2010) ______________________________________________                                             child’s/dependent’s name and photograph to promote and advertise the football camp for a period of two years after the date of this release. I
                                                                                                                   have read, or have had read to me, this release and waiver of claims statement and understand and voluntarily agree to its provisions.

Head Football Coach ________________________________ Shirt Size: _________                                         Signature of Parent/Guardian _________________________________________________________________________Date _______________

                                                                                                                   Child’s/Dependent’s Name & Telephone Number__________________________________________________________________
Parent/Guardian’s Name: ____________________________________________
                                                                                                                   AIRPORT PICK-UP (Overnight camp only): Is airport pick-up service needed? Yes ❏ No ❏ If yes, we require that you send a copy of your
Daytime Phone _____ - ________________ Evening Phone: ___________________                                          child’s airline schedule information including carrier, times, and flight numbers. Birmingham Airport pick-up can be arranged for additional
                                                                                                                   $30.00 fee. (payable with registration) Signature ________________________________________

Roommate request (list only one): __________________________________________                                       MEDICAL HISTORY: (To be completed by parents/guardian)
Both must be (1) pre-registered for camp, and (2) request each other as roommates for preference to be honored.)   Is there a known history of: A.) Birth Deformities (one eye, one kidney) etc. Yes ❏ No ❏
                                                                                                                   B.) Medical Conditions currently under treatment Yes ❏ No ❏
                                                                                                                   C.) Pre-existing injury currently under treatment Yes ❏ No ❏ D.) Fractures or other disability type injuries Yes ❏ No ❏
Position you want to play in camp (circle only one): RB QB WR TE OL DL LB DB                                       E.) Allergy (drugs, food, asthma, etc.) Yes ❏ No ❏
                                                                                                                   F.) Mental Disorder – Yes ❏ No ❏ G.) Known past illness of more than one week’s duration Yes ❏ No ❏
Full payment is due at time of application and is non-refundable. No partial payments are                          H.) Contacts or glasses Yes ❏ No ❏
accepted. Confirmation card will be sent upon receipt of registration and payment.                                 Explain above questions answered

                                                                                                                   I hereby state that the camp operators, its officers, employees, agents, volunteers, representatives, and the Board of Trustees of The University
                                                                                                                   of Alabama is not responsible for any pre-existing injury or reoccurrence or aggravation of any disclosed or undisclosed pre-existing injury or
                                                                                                                   illness of the above camper.

                                                                                                                   Signature of Parent/Guardian ____________________________________________________________________ Date ________________
Please check the session(s) you
will attend:                                                                                                       MEDICAL STATEMENT: Attach a copy of your previous year’s football physical to this form OR have your physician fill out and sign the
                                                                                                                   following medical statement.
❏ High School I (Grades 9-12): June 6-9
                      $360.00 (Overnight) $260.00 (Day camper)                                                     MEDICAL STATEMENT: I hereby certify that I have examined____________________________ and found him physically fit to attend and
                                                                                                                   participate in the Nick Saban Football Camp, and I know of no impairments which would limit his participation in football camp activities.
❏ Youth camp (Ages 8-14): June 13-16
                                                                                                                   Comments_________________________ Date of last tetanus immunization_________ Date examined________ Physician_________________
                            $360.00 (Overnight) $260.00 (Day camper)
                                                                                                                   Are you currently taking any
❏ High School II (Grades 9-12): July 18-21
                            $360.00 (Overnight) $260.00 (Day camper)                                                                                                       To enroll:
                                                                                                                                                           Complete and mail along with full payment to:
❏ Kicking Camp:              June 12                     $50.00
                                                                                                                                                                   Nick Saban Football Camp, LLC
❏ 7 on 7:                    June 19                      $50.00                                                                                                P.O. Box 2865 • Tuscaloosa, AL 35403
                                                                                                                                                                        Phone: 205-348-0808
❏ O-line / D-line:           June 19                      $25.00
                                                                                                                                                             Pre-registration deadline is June 1, 2010.
KEY DEPOSIT                                              $50.00                                                                                              Only cash, money order or cashiers checks.
*Key deposit for overnight campers only                                                                                                                        No Personal Checks will be accepted.

                                                                                                                                                                        Make check payable to:
                                                                                                                                                                     Nick Saban Football Camp LLC.