2024 Moosic Raiders Youth Football Camp

2024 Moosic Raiders

youth football camp online registration
Participant Details
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Grade Entering next school year
School District

Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Parent Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent email
example@example.com
Emergency Contact 1
Emergency Contact Name

First NameLast Name
Mobile Phone #
Home Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Participant
Emergency Contact 2
Emergency Contact Name

First NameLast Name
Mobile Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Participant

Registration confirmation
I understand that my camp registration is NOT complete until I have returned signed & dated copies of the additional forms containing Consent & Payment details.
I understand that my camp registration fee must be paid in full on or before the day of the camp (5/19) in order to participate.
Registration Fee/Payment

The $35 registration fee can be paid in-person on Sunday (5/19) before camp begins. Payment can be made using Cash, Check, or Venmo. Thank you!
Signature

parent/guardian signature
Date

MonthDayYear
Should be Empty: