ARCHIVE 2023 Summer Camp Detailed Registration Form

Prairie Grove Football Camp Registration

Prairie Grove High School Football Field - June 5, 6, & 7
Athlete Information
Athlete's Name*

First NameLast Name
Grade entering in FALL 2023*
If "other" please contact Danny Abshier or Nik Paroubek
T-shirt Size*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Do you need to sign up multiple children for camp?
CHILD #2: Athlete's Name

First NameLast Name
CHILD #2: Grade entering in FALL 2023
If "other" please contact Danny Abshier or Nik Paroubek
CHILD #2: T-shirt Size

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Do you need to sign up any other children for camp?
CHILD #3: Athlete's Name

First NameLast Name
CHILD #3: Grade entering in FALL 2023
If "other" please contact Danny Abshier or Nik Paroubek
CHILD #3: T-shirt Size

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Do you need to sign up any other children for camp?
CHILD #4: Athlete's Name

First NameLast Name
CHILD #4: Grade entering in FALL 2023
If "other" please contact Danny Abshier or Nik Paroubek
CHILD #4: T-shirt Size

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
If you're needing to sign up more than four children (AWESOME!), please list additional children's names, grade entering, and t-shirt size below
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does the athlete(s) have any serious allergies, chronic illness, or medical conditions that our camp staff needs to be aware of? If yes, please describe. If multiple athletes, please list their names along with the response.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Prairie Grove Football during the selected camp. In exchange for the acceptance of said child’s candidacy by Prairie Grove Football I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Prairie Grove Football and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Prairie Grove Football including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including football. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Prairie Grove Football and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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OPTIONS TO PAY

1) Pay safely and securely via Square. Use the payment setup below by selecting the amount of campers you are paying for and then complete your purchase. 2) Pay with cash by sending the money to the PG Elementary School office or PG Middle School office. Please make a note your child's name with any money sent in. 3) Pay with a check made out to "Prairie Grove Gridiron Club" and submit to the office the same way as cash

Square Online: Prairie Grove Gridiron Club

Camper Registration

$40.00 Quantity

Total

$0.00

Credit Card

Prairie Grove Football Camp 2023

We look forward to seeing you there!
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Prairie Grove Football Camp Registration

Athlete Information

OPTIONS TO PAY

Credit Card

Prairie Grove Football Camp 2023