THE DYNASTY YOUTH FOOTBALL CAMP SPEED & AGILITY PERSONAL TRAINING     ONLINE REGISTRATION Fill out the registration information below. After you click submit, you will see a link to the Consent For Participation form and a link to pay for camp online. Alternately, you can download the registration form and mail it in. Download Registration Form   CAMPER INFORMATION   Camper First Name Camper Last Name Age at time of camp Grade (2012-2013) Birthdate T Shirt Size Offensive Position OLRBWRQB Defensive Position DLLBDB Youth League & Team affiliation   PARENT INFORMATION   Parent/Guardian Name Home # Alternate # Email   EMERGENCY CONTACT   Name (other than parent) Relation to camper Phone #   MEDICAL & INSURANCE INFORMATION   Allergies Current Medications Previous injuries Date of last tetanus booster Health Insurance Provider Policy #   PAYMENT INFORMATION   Payment Method Online (after clicking submit)Cash or Check   WAIVER & RELEASE   The Dynasty Football Camp is operated as an individual enterprise and is not owned, sponsored, or operated by the city of Liberty nor the Liberty Public School District No. 53 I am aware of the dangers involved in participation in the physical activities of the Dynasty Football Camp and all activities related to the camp; these activities include, without limitation, practices and events. I am aware that the Dynasty Football Camp involves competition with and against other camp participants and that such participation may involve physical contact. With regard to such physical activity, I am aware that there is inherent danger and risk of injury. I also am aware that many of these injuries may be serious and may include, without limitation, damages to joints, ligaments, muscles, bones, neck, spine, and other parts of the body. Further, I am aware that activities related to the camp will involve the use of certain equipment. I am aware that such equipment in no way guarantees my safety from injury. Additionally, said equipment must be used in a proper manner; therefore, I will follow any and all instructions related to the use of equipment including those instructions provided by the manufacturer, equipment personnel, and coaches. My participation in the above events and in all activities related to the above events is a voluntary act with full and complete knowledge of the risks involved. I hereby voluntarily assume all such risks associated with my participation in the above events. Additionally, I agree to exonerate, save, indemnify, and hold harmless the Dynasty Football Camp, its owners, employees, and volunteers; the city of Liberty, the Liberty Public School District No. 53, its officers, agents, and employees--including without limitation, equipment personnel, and physicians and other practitioners of the healing arts--from any and all liability, claims, causes of action, or demands of any kind and nature whatsoever, including without limitation personal injury which may arise from or in connection with my participation in any activities related to the camp. The terms hereof shall serve as a release and assumption of risk for me, my parents or guardian, my heirs, estate, executor, administrator, assignees, and all members of my family. I have read and understand this acknowledgment and release and execute it as a free and voluntary act. Further, this acknowledgment and release is contractual and not a mere recital. I have read, understand and fully accept the terms of the above waiver and release.