1st Downs 4 Life Events

SECTION ONE

PARTICIPANT INFORMATION

Parent/Guardian must accompany participant at camp check-in and bring a government issued photo identification. Participant will not be allowed to check-in without a Parent/Guardian present.

Participants Name*

First Last

Age*

This form is for ages 8-13

Phone Number*

Address*

Street Address City State ZIP Code

Email*

T-Shirt Size*

Please Select One

PARENT/GUARDIAN INFORMATION

(Parent/Guardian must accompany participant at camp check-in. Participant will not be allowed to check-in without a Parent/Guardian present.)

Please fill out the information for Parent/Guardian (1) below.

Parent/Guardian (1) Name*

First Last

Parent/Guardian (1) - Phone #1*

Parent/Guardian (1) - Phone #2

Parent/Guardian (1) Address*

Street Address City State ZIP Code

Parent/Guardian (1) Relationship to Participant*

Do you need to enter information for a second Parent/Guardian?*

Check box to enter additional Parent/Guardian information.

Yes
No

Please fill out the information for Parent/Guardian (2) below.

Parent/Guardian (2) Name*

First Last

Parent/Guardian (2) - Phone #1*

Parent/Guardian (2) - Phone #2

Parent/Guardian (2) Address*

Street Address City State ZIP Code

Parent/Guardian (2) Relationship to Participant*

SECTION TWO

EMERGENCY CONTACT INFORMATION

Please enter the participants emergency contact information below.

Emergency Contact Name*

First Last

Relationship (to participant)*

Phone #1*

Phone #2

Email Address*

MEDICAL INFORMATION

Medical insurance is required in order to register a participant. Please fill out the info in full below. If you do not have insurance, you will not be able to submit the form.

Physician Name*

Insurance Company*

Physician Phone Number*

List allergies, medications or known medical problems:*

If none, please enter "none".

It is the responsibility of the Parent/Guardian to provide valid and current medical insurance information for the participant. 1st Downs 4 Life is not responsible should insurance information not be valid.*

I agree to the terms above and acknowledge that the participant does have valid medical insurance.

Date of Agreement*

MM/DD/YYYY

SECTION THREE

LEGAL STATEMENT AGREEMENT

1st Downs 4 Life Legal Statement

I/We, the parent(s) or legal guardian(s) of the above named child, hereby give my/our permission for him/her to participate in any and all Florida’s Elite Workout, Inc. activities during Louis Murphy, Jr.’s 1st Downs 4 Life Football and Cheerleading Camps. I/We for ourselves and on behalf of my/our child, hereby waive, release, absolve, and agree to hold harmless 1st Downs 4 Life, Inc., Florida’s Elite Workout, Inc., Louis Murphy, Jr., Lakewood High School, Pinellas County School District, all instructors, and all officers, directors, and personnel of these organizations, and all person(s) transporting my/our child to and from football camp activities or any claims arising out of injury to my/our child, except to the extent in any amount which may be covered by applicable accident and/or liability insurance, if any.

I/We the parent(s) or legal guardian(s) of the above named child do hereby grant and consent to full authority for the render of assistance, care, and treatment of the above named child under circumstances which shall reasonably be deemed an emergency, including without limitation: 1) I/We hereby give permission to the coaches and other persons of authority to administer first aid to the above named child; and 2) I/We hereby give permission to have the above named child transported by ambulance, police, or private vehicle to a hospital or doctor’s office if deemed necessary by the coaches and other persons of authority; and 3) I/We do hereby authorize the immediate treatment of the above named child by a licensed doctor and/or hospital personnel to the extent deemed necessary by such doctor and/or hospital personnel, including without limitation any diagnostic procedures, care, and treatment as may be deemed necessary.

Please agree to the information for Parent/Guardian below.

I, the parent or legal guardian of the above named child (in section one) agree in full with the legal statement above.

Please make selection to agree*

Yes, I agree with the above legal statement

Date of Agreement*

MM/DD/YYYY

ASSUMPTION OF RISK AGREEMENT

ASSUMPTION OF RISK LEGAL STATEMENT

PLEASE CONSULT A PHYSICIAN BEFORE PARTICIPATING IN ANY WORKOUT!

Please read the following legal statement completely, and fill out the agreement form below.

In consideration of participant (either self or minor dependent) permission to participate in workouts by Florida’s Elite Workout, Inc. during the Louis Murphy, Jr.’s 1st Downs 4 Life Inc., Football and/or Cheerleading Camps, I hereby assume all responsibility for risk of injury or damage that may occur to the participant arising during participation in such workouts. In participating in these workouts, the participant does so totally at the participant’s own risk. Neither 1st Downs 4 Life, Inc., Florida’s Elite Workout, Inc., Louis Murphy, Jr., Lakewood High School, Pinellas County School District, all instructors, member organizations, or the facility at which workouts occur, or any of their respective owners, shareholders, directors, related corporations, sponsors, coaches, trainers, employees or agents, shall be liable for any injuries or damages sustained by the participant in, on, or, about the premises where the workouts shall be conducted.

I (either self or minor dependent) hereby fully and forever release and discharge 1st Downs 4 Life, Inc., Florida Elite Workout, Inc., member organizations and the facilities at which the workouts shall be conducted and their respective owners, shareholders, directors, related corporations, sponsors coaches, employees and agents, from any and all claims, demands, expenses, rights of action, or causes of action, present or future, whether the same be known, anticipated or unanticipated, of any and every nature, resulting from or arising out of particular equipment, exercise and trained technique and agree that the participant should comply with these requirements during all activities.

Consent for use of photographic/video and sound: I also give permission to 1st Downs 4 Life, Inc. to use photographic/video images of myself and/or my child with or without voice, for educational and promotional purposes and/or for broadcast by 1st Downs 4 Life, Inc.

Please agree to the information for Parent/Guardian below.

I, the parent or legal guardian of the above named child (in section one) agree in full with the legal statement above.

Please make selection to agree*

Yes, I agree with the assumption of risk statement above

Date of Agreement*

MM/DD/YYYY

I understand that a Parent/Guardian must accompany participant at camp check-in and bring a government issued photo identification. A participant will not be allowed to check-in without a Parent/Guardian present.*

Yes, I understand the statement above

I authorize the people listed below to drop and/or pick up the participant listed above

List Names Here. (If none, please enter none.)*

Please enter the text seen below

The CAPTCHA text is a security measure for this form. Please enter the text exactly as seen below to send the form. Thank you.

2019 Football Camp – Ages 14-18

June 29, 2019 – 11:00am – 5:00pm

Register Today – Form below is for ages 14-18

2019 FOOTBALL REGISTRATION FORM - Ages 8-13 (1)

PARTICIPANT INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

MEDICAL INFORMATION

LEGAL STATEMENT AGREEMENT

1st Downs 4 Life Legal Statement

ASSUMPTION OF RISK AGREEMENT

ASSUMPTION OF RISK LEGAL STATEMENT

I authorize the people listed below to drop and/or pick up the participant listed above

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