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Youth Football and Youth Football Camp Sign-Ups

2012 BUTLER COUNTY YOUTH FOOTBALL SIGN UP
AND BUTLER COUNTY YOUTH FOOTBALL CAMP

Sign-ups:  This sign up is for both the 2012 Youth Football Season and the 2012 Butler County Youth Football Camps.  You can fill out forms and send back to school with $50.  This cost covers both the 2012 Youth Football Season and 2012 Youth Football Camp.  Make check out to Butler County Quarterback Club.  We will sign players up June 9 from 10:00-4:00 pm at BCHS GAME FIELD.

Cost:  $50 per camper.  This includes both the camp and 2012 Youth Football Season Sign Up Fee.

Camp Dates:  June 11-15 from 5:00 pm -7:00 p.m.

Location:  BCHS practice field.

Camp Features:  Campers will work on the fundamentals of the game including technique, speed, agility, and strength.

Equipment:  Shorts, socks, t-shirt, and cleats.  *Special note- In case of rain, campers need to bring shoes because we will be going in the gym or Athletic Facility.

Questions:  Call Ryan Emmick  270-999-4161 or Mike Elmore 270-999-1556

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BUTLER COUNTY HIGH SCHOOL YOUTH FOOTBALL CAMP/YOUTH FOOTBALL SEASON SIGN UP
2012

Camper Name: ________________Age: ______
Grade: ____
Address: __________________________________________
City: ________________________ State: ____ Zip: ______
Guardian Name(s): __________________________________
Guardian Home Phone:______________ Work: __________
Cell: ________________________
Offensive Position: ________ Defensive Position: ________

Emergency Contact Information (If different than above):
Relationship: ________________________________________
Name: ______________________Ph No.: ______________
Insurance carrier: ____________________________________
Policy number: ______________________________________
Carrier’s phone number: ______________________________

I AM THE PARENT OR GUARDIAN OF THE NAMED CHILD WHO IS A CANDIDATE TO PARTICIPATE AT THE BUTLER COUNTY YOUTH FOOTBALL CAMP. I HEREBY GIVE MY APPROVAL TO THE PARTICIPATION IN ANY AND ALL OF THE ACTIVITIES OF THE CAMP 2011. INCLUDED BUT NOT LIMITED TO PRACTICES, DRILLS, GAMES, TOURNAMENTS, WEIGHT TRAINING INSTRUCTION, IF ANY, AND ANY OTHER ACTIVITY ASSOCIATED WITH THE CAMP ON AND AFTER THE DATE HEREOF. IN CONSIDERATION OF YOU PERMITTING MY CHILD TO PARTICIPATE IN THE CAMP AND THE ACTIVITIES, AND IN CONSIDERATION OF THE TIME AND EFFORT DEVOTED BY THE COACHES AND SUPERVISORS AND STAFF OF THE CAMP. I ASSUME ALL RISKS AND HAZARDS TO INCIDENTAL TO THE CONDUCT OF THE ACTIVITIES AND TRANSPORTATION TO AND FROM THE ACTIVITIES.

Signature:__________________________________________________

Date:____________________

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