2015 Pekin Football Youth Camp Registration Form

3rd-5th Grade Athletes

Dates: Monday, J uly 27, 2015-Friday, July 31, 2015 @ 9:00-10:30
Cost: If paid by July 1st $40.00
After July 1st $50.00
Where: Meet At Pekin Memor ial Stadium
6th-8th Grade Athletes
Dates: Monday, J uly 27, 2015-Friday, July 31, 2015 @10:30-12:00
Cost: If paid by July 1st $40.00
After July 1st $50.00
Where: Meet at Pekin Memor ial Stadium
Registration forms and fees need to be turned into or mailed to the Pekin Community High School Athletic Office by Friday, July 10, 2015.
Parents are welcome to pay registration fees on the first day of camp.
Make Checks payable to Pekin Football
Mail in registration and fees to :
PCHS Athletic Office
Summer Football Camp Registration
1903 Court Street
Pekin, IL 61554
Camp T-Shirt Size (Please check the appropriate line)
Youth (S)

Youth (M)

Youth (L)

Adult (S)

Athletes Name:

Age:

Adult (M)

Adult (L)

Adult (XL)

Grade:

Parent(s)/Guardian(s) Names:
Address:
City:

Phone:
State: IL

Zip Code:

School Attending:
Waiver of Liability and Acknowledgement of Warning Athletic Agreement Consent Form
I, the undersigned parent or guardian of
acknowledge that Pekin Community High School District #303
does not provide school accident insurance for students participation in summer camps. I understand that I must obtain insurance for accidental injury to my child/ward. Further, I hereby acknowledge that I have been properly advised, cautioned, and warned by the proper administrative, teaching, and coaching personnel of District #303 that by participating in sport/activities I hereby release, indemnify, and hold
harmless Pekin Community High School District #303, its Board members, agents, employees, and officers from any and all claim for personal injury and property damage which my child/ward may incur by such participation in sports/activities. I do hereby acknowledge that I
have been fully advised, cautioned, and warned by the proper administrative and coach personnel of Pekin Community High School District #303 that my child/ward named above may suffer serious injury, including but not limited to sprains, fractures, brain damage, paralysis, or even death by participating in sports/activities. Notwithstanding such warnings, and with my full knowledge and understanding of
the risk of serious injury which may result to my child/ward named above, I give my consent for
to participate
in sports/activities. I also understand that my student-athlete will be expected to obey the rules and regulations set forth by the Athletic
Policy Handbook, the Illinois High School Association, and as explained by the athletic coach/advisor on the first day of practice.

Parent/Guardian Signature:

Date: