Western Football Camp Campers will get instruction from coaches with over 50 years experience combined. Campers Will Be Instructed In: *Proper Tackling Form *Catching *Passing *Running *Kicking *Blocking *Stance / Starts
Western Panthers football camp
Campers Will Have Opportunities To: *Compete Against Campers *Air Force Football *Win Prizes *Every camper will receive a Western Football T-Shirt Contact Information:
***Please Make Checks Payable To: Western High School
Office Phone:(765) 883-5576 Ext: 4060
***Mail Payment & Completed Forms To:
Fax Number: (765) 883-7946
Western High School 2600 S 600 W Russiaville, IN 46979 Attn: Coach Jankovich / Josh Larsh
Email:
[email protected] Address: 2600 S 600 W Russiaville, IN 46979 Attn: Football Office
1st – 5th Grade
6th – 8th Grade
GRADES 1st THROUGH 5th (MIN. AGE 5)
GRADES 6th THROUGH 8th
TIME: 4:30 PM to 6:00 PM
TIME: 6:00 PM to 7:30 PM
DATE: July 20th THROUGH July 22nd
DATE: July 20th THROUGH July 22nd
LOCATION: Western Stadium
LOCATION: Western Stadium
COST: $35 Per Player
COST: $35 Per Player
Check In Will Begin At 4:00 PM T-SHIRT FOR EVERY CAMPER!!
Check In Will Begin At 5:30 PM T-SHIRT FOR EVERY CAMPER!!
NAME: ______________________________
NAME: ______________________________
ADDRESS:____________________________
ADDRESS:____________________________
CITY:________________________________
CITY:________________________________
STATE:
STATE:
ZIP:____________________
ZIP:____________________
HOME PHONE:________________________
HOME PHONE:________________________
CELL PHONE:_________________________
CELL PHONE:_________________________
E-MAIL:______________________________
E-MAIL:______________________________
GRADE:______________________________
GRADE:______________________________
POSITIONS:___________________________
POSITIONS:___________________________
HEIGHT:
HEIGHT:
I request that the athlete named above be admitted to the Western Panthers Football Camp and I authorize the Directors and Coaches to act for me according to their best judgment in any emergency requiring medical attention. I understand there will be a qualified athletic trainer available at all times. I waive, release and forever discharge the Western Panthers Football Camp and Western High School, it’s officers, directors, staff, agents, coaches, representatives, employees of, and from, any and all rights and claims for damages to person or property which may be sustained or occur during participation in the combine activities. Parent printed name__________________________
Parent Signature_____________________________
Date_______________________________________
WEIGHT:_____________
CIRCLE T-SHIRT SIZE: YS YM YL YXL S
M
L
XL
WEIGHT:_____________
CIRCLE T-SHIRT SIZE: YS YM YL 2XL
3XL
S
M
L
YXL XL
2XL
3XL
Home Phone________________________________
Cell Phone__________________________________