North Kitsap Athletic Booster Club

Junior Viking Football Camp

Childs Name:________________________________ Age:_____________

Parent Name:____________________________ Contact Number: _________________

Email address:__________________________________________________________

Emergency Contact Name:_____________________ Phone Number:________________

Does your child have any medical conditions that we need to be made aware of:
____________________________________________________________________
____________________________________________________________________

Is your child currently taking any medication?:_______ if Yes, Please indicate what
medicine and attach directions if we need to administer:
____________________________________________________________________
____________________________________________________________________

Allergies:
____________________________________________________________________
____________________________________________________________________

Childs Physician:_____________________ Physician Number:____________________

Shirt size

XS___ SM____ MED ___ L __ XL ____ XXL ___ XXXL___

I _______________________ hereby allow my child __________________________

to participate in the Junior Viking Football Camp. The Junior Viking Football camp , and the
volunteers are not liable for any injury that may occur. The North Kitsap School District
does not sponsor this event and the North Kitsap School District assumes no responsibility
for it. In consideration of the opportunity to distribute materials, the North Kitsap School
District shall be held harmless from any cause of action filed in any court or administrative
tribunal arising out of the distribution of these materials, including costs, attorneys fees
and judgments or awards.

Signature of Parent:_____________________________________ Date:___________

Mail registration form to : NKAB PO Box 1365, Poulsbo, Wa. 98370 or bring the registra-
tion form the first day of camp, make checks payable to NKAB