Jan 4 Pop-Up "Bring Your Brother" Camp

Athlete's Name

First NameLast Name

Athlete's D.O.B

Grade Level for 2024-25 School Year:

Positions played or hope to play (select all that apply):

WR/DB/TE/FBRB/LBQBOL/DL

Add a Second Athlete?

2nd Athlete's Name

First NameLast Name

2nd Athlete's D.O.B

2nd Athlete's Grade Level for 2024-25 School Year:

2nd Athlete's Positions played or hope to play (select all that apply):

WR/DB/TE/FBRB/LBQBOL/DL

Add a 3rd Athlete?

3rd Athlete's Name

First NameLast Name

3rd Athlete's D.O.B

3rd Athlete's Grade Level for 2024-25 School Year:

3rd Athlete's Positions played or hope to play (select all that apply):

WR/DB/TE/FBRB/LBQBOL/DL

Parent's Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name

First NameLast Name

Emergency Contact Number

Please enter a valid phone number.

Release & Liability

In consideration of my child(ren) being allowed to participate in any way for the ORIGINS FOOTBALL ACADEMY program for the 2025 season, it's related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential risk for permanent paralysis and death, and while particular rules, equipment and personal disipline may reduce the risk, the risk of serious injury does exist; and

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsilbity for my participation; and I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe an unusual and significant hazard during my presence or participation, I will bring such to the attention of the nearsest official immediately; and

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless ORIGINS FOOTBALL ACADEMY, and it's officers, officials, agents and/or volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability, death, or loss or demage to person or property, wheather arising from the negligence of the releases or otherwise, to the fullest extent by law.

If a child(ren) leaves a practice or game for any medical reason, he or she cannot return without medical clearance from a physician. At any time, a coach can require medical clearance of a player to be able to participate or play at his/her own discretion.

I have read this release of liability and assumption of risk agreement. I fully understand its terms. I understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

Signature

Pop-Up "Bring Your Brother" Camp (Brothers Are 1/2 Price)

All positions welcome. Fundamentals, speed and agility, position work. Athletes and brothers 10 and older welcome.

PAYMENT DUE AT BEGINNING OF CAMP, CASH or VENMO