gridiron ready - YMCA of Greater Williamson County

GRIDIRON
READY
Jeremy Kerley Camp
Saturday, June 20
THIS CAMP HAS 2 SESSIONS
at the Hutto High School Football Field
Session 1 (1st-7th Grade Boys)
9:00 a.m - 12:00 p.m.
Session 2 (7th-12th Grade Boys)
NFL Football Clinic
1:00 p.m. - 4:00 p.m.
YMCA OF GREATER WILLIAMSON COUNTY
This camp will offer quality instruction of football fundamentals and help players have
fun while they learn proper mechanics. Life skills, focus and support are all a big part of
football and our player coaches want to do their part to help keep those traditions alive.
ymcagwc.org
©iStockphoto.com/Cybernesco
This camp, which has two sessions, is limited to 150 participants per session.
Cost is $40 for Y Members and $60 for Community. (Financial Assistance is available)
l All participants receive a Clinic T-Shirt.
l Proceeds from the clinics go to benefit the Y’s Annual Campaign, which provides financial aid scholarships to those in need.
l Questions? Contact your local YMCA: CHASCO (512) 246-9622, Hutto (512) 846-2360, or Twin Lakes (512) 250-9622
l
l
NFL FOOTBALL CLINICS REGISTRATION FORM
NAME OF CHILD: _________________________________________________ GENDER: _______
GRADE: _______
ADDRESS: ________________________________________________________________________________________________
D.O.B.: _____________________
CITY: _________________________
STATE / ZIP: ______________________
PARENT / GUARDIAN NAME(S): _________________________________________________________________________
HOME PHONE: __________________________________
CELL / WORK PHONE: __________________________
E-MAIL: __________________________________________________________________________________________________
CLINIC OPTIONS
DATE
Jeremy Kerley Camp
Jun 20
Y STAFF ONLY
SESSION 1 SELECTION (1st-7th Grade)
Registration Completed: ____________
Date: _________________
SESSION 2 SELECTION (7th-12th Grade)
Initials: _____________
Please INITIAL or ANSWER all lines to indicate received written policies / materials and agree to terms with SIGNATURE below.
______________ ADA Policy (Required): Parents have the obligation to disclose significant, medical, physical or behavioral issues at the time of the
child’s enrollment and on an ongoing basis. Due to the large group format of our program, we are unable to provide one-on-one care for
any child except on an intermittent basis, such as injuries, immediate disciplinary issues and certain personal care needs customarily
provided to other children.
______________ Waiver for Medical Treatment (Required): In the event that my child requires emergency treatment and I cannot be reached, I hereby
authorize the Y to make arrangements to transport my child to the nearest hospital emergency facility. I also give my consent for any and
all necessary medical treatment, if, in fact my child require the attention of a physician.
______________ Waiver for Participation (Required): I understand that Y activities have inherent risks and I hereby assume responsibility for all risks
and hazards to my child in the participation of these activities. I further waive, release, absolve, and agree to hold harmless the Y, the
organizers, volunteers, supervisors, officers, directors, participants from any claims or injury sustained during my child’s use of the
facilities or participation in the Y program.
______________ Waiver for Photo / Video / Audio Release (Optional): I give my consent for any photos, video and/or audio taken of my child involved
in Y programs to be used for Y promotions, trainings and/or displays.
______________ Change / Cancellation / Refund Policy (REQUIRED): I understand that changes / cancellations / refunds are not permitted unless a
physician’s note is submitted stating the inability to complete the clinic. The Y reserves the right to adjust, combine, separate and
place participants in divisions for all leagues and/or clinics. All Rosters and/or Schedules are Final - No Exceptions. Each player signs up
as an individual, not as a group or team. For any questions, please contact the CHASCO Family YMCA at (512) 246-9622.
Parent / Guardian Signature: ______________________________________________________________________ Date: ______________________________________
CHASCO FAMILY YMCA
1812 N. Mays St., Round Rock, TX 78664
P 512 246 9622 F 512 244 7381
TWIN LAKES FAMILY YMCA
HUTTO FAMILY YMCA
204 E. Little Elm Trail, Cedar Park, TX 78613 200 Alliance Blvd., Hutto, TX 78634
P 512 246 9622 F 512 615 7401
P 512 846 2360 F 512 846 2484
Approval of distribution of this material is no way an endorsement of such services,
activities and/or products by the Independent School District.