2011 Big Dawg Line Camp
Southern Illinois University BIG DAWG LINE CAMP June 25, 2011 The Big Dawg Line camp is scheduled in conjunction with the 7 on 7 passing tournament. The Big Dawg camp is a helmet and shoulder pad camp that provides drill instruction and technique work for the lineman both offensively and defensively. This camp is offered for athletes entering 9th through 12th grades. The camp fee is $40. Campers are expected to provide their own helmets, shoulder pads, cleats and mouth piece. The day will provide sessions of run blocking and pass blocking for the offensive lineman. Defensively campers will learn how to rush the passer and defeat run blocks. In order to guarantee a camp t-shirt, please detach the registration form and return it with your payment of $40 by June 17th! Cost of camp will be $50 for any registrations submitted after June 17th. Application & Registration Form for 2011 SALUKI Big Dawg Line Camp PLEASE PRINT Please include check with registration form.
NAME:___________________________________ AGE:________ HEIGHT:_________WEIGHT:_________ ADDRESS:_______________________________CITY:____________________________________________ STATE:____________ ZIP:_____________ ADULT SIZE T-SHIRT (CIRCLE)
M
L XL XX XXXL
GRADE (FALL 2011) ________ SCHOOL ATTENDING (FALL 2011)_______________________________ HOME PHONE (
) _____________________ DAYTIME PHONE (
) __________________________
EMAIL ADDRESS ____________________________________ Checks payable to: Southern Illinois University $40 Camp Fee Contact: Coach Steve Crutchley Phone: 618-453-3332 Email: [email protected] Please mail to: SIU Saluki Football Camps 128 Lingle Hall Carbondale, IL 62901-6620
After June 18th $50 Camp Fee
**See consent form on reverse side. This form must be completed to attend camp!
Indemnification By Parents or Guardian of Applicant I give permission for my child to participate in the Southern Illinois University Football Camp knowing it will contain physical activity that could lead to injury. To the best of my knowledge (participant’s name), ____________________________ is physically capable of performing activities related to this camp. I release and hold harmless Southern Illinois University. Including, but not limited to, its trustees, officers, employees, representatives, agents, and affiliates, from any and all liabilities, personal injuries, and damages to or loss of personal injuries, and damages to or loss of personal property arising, directly or indirectly, in condition with my child’s use of the facilities and equipment of the specific camp site. I give permission for my child to be treated by the appropriate personnel for any illness/accident while at camp. Print Name ____________________________________ Phone # (____) ___________________________ or Phone # (____) __________________________ Insurance Provider ___________________________ Insurance Policy # ___________________________ Primary Insurance Holder ______________________ ________________________________________ Parent/ Guardian Signature
NAME:___________________________________ AGE:________ HEIGHT:_________WEIGHT:_________ ADDRESS:_______________________________CITY:____________________________________________ STATE:____________ ZIP:_____________ ADULT SIZE T-SHIRT (CIRCLE)
M
L XL XX XXXL
GRADE (FALL 2011) ________ SCHOOL ATTENDING (FALL 2011)_______________________________ HOME PHONE (
) _____________________ DAYTIME PHONE (
) __________________________
EMAIL ADDRESS ____________________________________ Checks payable to: Southern Illinois University $40 Camp Fee Contact: Coach Steve Crutchley Phone: 618-453-3332 Email: [email protected] Please mail to: SIU Saluki Football Camps 128 Lingle Hall Carbondale, IL 62901-6620
After June 18th $50 Camp Fee
**See consent form on reverse side. This form must be completed to attend camp!
Indemnification By Parents or Guardian of Applicant I give permission for my child to participate in the Southern Illinois University Football Camp knowing it will contain physical activity that could lead to injury. To the best of my knowledge (participant’s name), ____________________________ is physically capable of performing activities related to this camp. I release and hold harmless Southern Illinois University. Including, but not limited to, its trustees, officers, employees, representatives, agents, and affiliates, from any and all liabilities, personal injuries, and damages to or loss of personal injuries, and damages to or loss of personal property arising, directly or indirectly, in condition with my child’s use of the facilities and equipment of the specific camp site. I give permission for my child to be treated by the appropriate personnel for any illness/accident while at camp. Print Name ____________________________________ Phone # (____) ___________________________ or Phone # (____) __________________________ Insurance Provider ___________________________ Insurance Policy # ___________________________ Primary Insurance Holder ______________________ ________________________________________ Parent/ Guardian Signature
