Watertown April Flag Football
First Name
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Last Name
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School
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Grade
*
Street Address
*
City
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Zip
*
State
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Position Offense
Position Defense
Height
Weight
E-mail address for receipt
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Twitter Handle
Parent Name
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Parent email
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Parent phone
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The signed participant has my permission to participate in this Clinic. I understand and accept the condition that neither the NE Elite Sports Clinics, Inc. it’s 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. By hitting submit I am hereby giving my parent/guardian consent
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Yes
Insurance Company & Policy #:
*
Amount Due
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Clinic Payment
$150.00
$
150.00
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