QB Academy

First Name *

Last Name *

School *

Grad Year

E-mail address for receipt *

E-mail address for Player *

example@example.com

Twitter name

Parent Name *

Parent Email *

Parent Phone *

The signed participant has my permission to participate in the Elite FootballClinic/Academy we are registering for. I am aware that the participant’s contactinformation will be shared with college football coaches for recruitingpurposes. This information will also be shared with our corporate sponsors sothat they may promote their products. I am giving permission to use any photos,taken at the clinic of the signed participant, on our Clinic websites. Iam aware of the refund policy stated on the Clinic page. I understand andaccept the condition that neither the Elite High School Football Clinics, Inc.,its directors, nor coaches, or the site of the clinic or school affiliated withthe site will assume responsibility for medical and dental expenses incurred asa result of participation in this clinic. I confirm that the participant haspersonal medical insurance coverage and that any expenses incurred while at theclinic are my responsibility. In case of an emergency, I understand that everyattempt will be made to contact the person listed. If contact is unsuccessful,I give permission to the attending medical personnel to render medicaltreatment to the participant. *

Yes

Insurance Company & Policy #: *

Amount Due

Payment $ 100.00

QB Academy Classroom Session