NE Youth Clinic Player Application

Name:  _________________________________________________________

Address: _______________________________________________________

             
                 _______________________________________________________

School:    ______________   Fall 2010 Grade: ____     Phone: ____________

Release Form and Policies

The above participant has my permission to participate in the New England Football Clinic. I understand and accept the condition that neither the NE Camps, Inc., its directors or coaches or the site owner will assume responsibility for medical and dental expenses incurred as a result of participation in this clinic. I also confirm that the participant has personal medical insurance coverage and that any expenses incurred while at the clinic is my responsibility. In case of an emergency, I understand that every attempt will be made to contact the person listed. If contact is unsuccessful, I give permission to the attending medical personnel to render medical treatment to the participant.

Parent Signature____________________________________________________

Emergency Phone #         _____________________________________________

Insurance Company & Policy #:    ______________________________________