YOUTH FOOTBALL CAMPs
Minnesota State University Moorhead Department Of Intercollegiate Athletics Youth Programs Consent For Participation And Medical Information Dragon Youth Football Camp Child’s Name ___________________________ Age ________ In case of emergency, contact __________________________ Emergency contact phone #____________________________ Medical Insurance Co.________________________________ Policy No. _____________________ Group No. ____________ Physician Name ___________________________________ Phone __________________________________________ Medical conditions the youth program staff and medical emergency services personnel need to be made aware of: ______________________________________________ ______________________________________________ I wish to register my minor child, ____________________ and consent to my child’s participation in the Summer Sports Camps and/ or Leagues sponsored by the Department of Intercollegiate Athletics of Minnesota State University Moorhead during the summer. I recognize that participation in recreational and instructional activities, even when well supervised and managed, pose a risk of physical injury to my child, and I agree to assume such a risk on behalf of my child. I understand that children registered for MSUM Athletics’ summer sport camps and/or leagues will receive instruction in the basic principles of sport(s) of their choice(s) and will spend a significant amount of time practicing and performing sporting techniques and/or researching and performing a variety of enrichment techniques under the supervision of experienced instructors, and I consent to my child’s participation in this program. I certify that my child has no medical condition or impairment, including the use of medication, that might inhibit his participation.
RELEASE OF LIABILITY I, the undersigned, hereby hold Minnesota State University Moorhead and the entire MSUM Dragon Athletics' Staff harmless from liability for any and all medical and/or accident expenses which my minor child may incur during his involvement in the Summer Sports camps and/ or leagues at the Department of Intercollegiate Athletics, MSUM. I hereby certify that my child is provided coverage via personal health and accident insurance in effect which is sufficient to cover any and all of the expenses, noted above, which might incur. Parent/Guardian Signature: ____________________________ Print Parent/Guardian Name:___________________________
JULY 18-19, 2018 Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State system. This information will be made available in alternate format, or if a disability-related accommodation is required, please contact Accessibility Resources at 218.477.4318 (voice) or 1.800.627.3529 (MRS/TYY).
YOUTH FOOTBALL CAMPs
▸ Certified trainers will attend all practices and water will be available at all times ▸ Cost of camp is $45 (additional $5 fee for walk-ups)
Camp Information ▸ Check in will be done in the main Nemzek Lobby ▸ Pick up will be at the north west corner of Scheels field. Questions? [email protected], Office - 218-477-2893
10:15 AM Competitions 11:30 AM
Depart Camp
DAY 2 – Thursday, July 19th Grades (1-4) (5-8) 8:45 AM Arrive 9:00 AM
Camp start
10:00 AM
Break: snack/Water
10:15 AM Competitions 11:15 AM
Camp Roundup/Awards
For more information contact Kevin Murphy at 218-477-2893 or email @ [email protected]
Break: snack/Water
Online Registration can be found at www.msumdragons.com
10:00 AM
Mail $45 payment and application to: Dragon Youth Camp MSUM Football Offices Attn: Kevin Murphy 1104 7th Ave S Moorhead, MN 56563 (Checks payable to MSUM Dragon Football)
▸ Campers can bring either cleats or tennis shoes
Camp start
School _________________________________________________ Grade (Fall of 2018) ________ Age________
▸ If we have bad weather those days, camp may be canceled for camper safety
9:00 AM
In case of an emergency information (Name, #)_________________________________________________________
▸ Grades 1 through 4 will practice on the North end of Scheels Field. ▸ Grades 5 through 8 will practice on the South end of Scheels Field.
Registration/arrival
Insurance Company_________________ Policy Number________________________________________________
Camp Information
8:30 AM
Phone (Home)_____________________ Parent Email_________________________________________________
GO DRAGONS!
DAY 1 – Wednesday, July 18th Grades (1-4) (5-8)
Address__________________________________ City_____________________ State_______ Zip___________
Welcome to our annual Dragons Football Youth Camp! We are very excited to continue this tradition with the families of the F-M Area! As a staff, we are very excited to open our program to the community and continue to share our knowledge of the game of football! Over the course of the whole day, your sons and daughters will be taught by the whole Dragons staff and some of the current players! While at camp, we will focus on keeping the game fun for the kids, introducing and improving on the basics. We hope you’re as excited as we are and we look forward to seeing you soon!
Camper’s Name______________________________________________________________________________
Dear Campers and Parents,
Dragons Youth Football Camp Schedule 2018 MSUM dragons youth football Camp Registration Form
Message from the Dragons Staff
RELEASE OF LIABILITY I, the undersigned, hereby hold Minnesota State University Moorhead and the entire MSUM Dragon Athletics' Staff harmless from liability for any and all medical and/or accident expenses which my minor child may incur during his involvement in the Summer Sports camps and/ or leagues at the Department of Intercollegiate Athletics, MSUM. I hereby certify that my child is provided coverage via personal health and accident insurance in effect which is sufficient to cover any and all of the expenses, noted above, which might incur. Parent/Guardian Signature: ____________________________ Print Parent/Guardian Name:___________________________
JULY 18-19, 2018 Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State system. This information will be made available in alternate format, or if a disability-related accommodation is required, please contact Accessibility Resources at 218.477.4318 (voice) or 1.800.627.3529 (MRS/TYY).
YOUTH FOOTBALL CAMPs
▸ Certified trainers will attend all practices and water will be available at all times ▸ Cost of camp is $45 (additional $5 fee for walk-ups)
Camp Information ▸ Check in will be done in the main Nemzek Lobby ▸ Pick up will be at the north west corner of Scheels field. Questions? [email protected], Office - 218-477-2893
10:15 AM Competitions 11:30 AM
Depart Camp
DAY 2 – Thursday, July 19th Grades (1-4) (5-8) 8:45 AM Arrive 9:00 AM
Camp start
10:00 AM
Break: snack/Water
10:15 AM Competitions 11:15 AM
Camp Roundup/Awards
For more information contact Kevin Murphy at 218-477-2893 or email @ [email protected]
Break: snack/Water
Online Registration can be found at www.msumdragons.com
10:00 AM
Mail $45 payment and application to: Dragon Youth Camp MSUM Football Offices Attn: Kevin Murphy 1104 7th Ave S Moorhead, MN 56563 (Checks payable to MSUM Dragon Football)
▸ Campers can bring either cleats or tennis shoes
Camp start
School _________________________________________________ Grade (Fall of 2018) ________ Age________
▸ If we have bad weather those days, camp may be canceled for camper safety
9:00 AM
In case of an emergency information (Name, #)_________________________________________________________
▸ Grades 1 through 4 will practice on the North end of Scheels Field. ▸ Grades 5 through 8 will practice on the South end of Scheels Field.
Registration/arrival
Insurance Company_________________ Policy Number________________________________________________
Camp Information
8:30 AM
Phone (Home)_____________________ Parent Email_________________________________________________
GO DRAGONS!
DAY 1 – Wednesday, July 18th Grades (1-4) (5-8)
Address__________________________________ City_____________________ State_______ Zip___________
Welcome to our annual Dragons Football Youth Camp! We are very excited to continue this tradition with the families of the F-M Area! As a staff, we are very excited to open our program to the community and continue to share our knowledge of the game of football! Over the course of the whole day, your sons and daughters will be taught by the whole Dragons staff and some of the current players! While at camp, we will focus on keeping the game fun for the kids, introducing and improving on the basics. We hope you’re as excited as we are and we look forward to seeing you soon!
Camper’s Name______________________________________________________________________________
Dear Campers and Parents,
Dragons Youth Football Camp Schedule 2018 MSUM dragons youth football Camp Registration Form
Message from the Dragons Staff
