Camps

All information below is required before the form can be submitted.

1 - CHOOSE YOUR CAMP(S)
	Speed and Agility Camp - $50	3-Day Mini Camp:
			Day Camp - $375
			Overnight - $450

2 - PROVIDE CAMPER'S INFORMATION
Campers Name:
Street:		Apt:
City:		State:	Z IP:
Home Phone:		Work Phone:
Email Address:
Your age when camp begins:		Current Grade:
School/Club you play for:
School you attend:
How many times have you attend this camp:		How did you learn about this camp:
		If it was through a newspaper, which paper:
		If it was through a friend, friend's name:

Roommate Preference:

Do you need transportation from the airport to the camp? (additional $20)		Do you need transportation from the camp to the airport? (additional $20)

T-Shirt Size (Adult):

3 - PROVIDE CAMPER'S MEDICAL INFORMATION
Birth Date:	(mm/dd/yyyy)
Parents' Names:
Emergency Contact:		Phone:
Insurance Company:		Policy Holder's Name:
Address of Insurance Company:
	City:	State:	ZIP:
List all mediciations camper currently is taking:

List all medicial conditions currently under treatment:

Is camper allergic to any medications:		If yes, list allergies:

I hereby state that the A3 Specialists Football Camp is not responsible for any pre-existing injury or recurrence of any undisclosed pre-existing injury or illness of the above camper prior to the first day of camp. I indemnify and hold harmless the A3 Specialists Football Camp as well as its representatives from any claims for personal illness or injury that my son/daughter may sustain during camp. I hereby give my consent for the camper above to be treated for injuries and medical problems.

	* I have read the above statements and agree to them.