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Football Registration Form

Registration

Participant Name:

Address:

City:

Province:

Postal code:

Phone(H): Cell:

Age:

Date of Birth:

Allergies:

Medication:

Jersey Size (adult): :

Preferred Roommate:

Grade:

School:

Offensive Position: Defensive Position:

Number of years playing football:

Parent / Guardian:

Phone No: (H): (W):

Email address::

Please Circle Below:

Residence Camper:

$375

Residence Camper (Students in Football New Brunswick) :

$250

Day Camper:

$200

Payment Method:

Registration is on a first come, first serve basis. Full payment is required at time of registration

Check Credit Card ( Visa/MC)

If paying by credit card, you will be provided with a “Pay Online” option following the submission of this form.

If paying by check: Please mail your cheques (with the participant’s name & the camp he/she is attending printed on the check) payable to Mount Allison University to the following address:

Mail:
Summer program
Mount Allison University
155 Main Street,
Sackville, NB, E4L 1B5

Refunds:

There will be a $25.00 administration fee applied to all cancellations where a medical note is not provided. Absolutely no refunds after Wednesday, May 16, 2012.

Patental Consent Form

I acknowledge that participation in athletics and recreation activities involves the risk of personal injury. In consideration of the use of the facilities, premises and equipment of Mount Allison University (“University”) by my child for athletics and/or recreation activities, I accept that risk, on behalf of my child, regardless of the nature of the injury. I agree and understand that the University, its officers, employees, agents and representatives shall not be liable for any personal injury, death, loss of property or damage as a result of my child’s participation in athletics and/or recreation activities at the University, whether caused directly or indirectly by the fault or negligence of the University, its offices, employees, agents or representatives or otherwise. I hereby release, indemnify and hold harmless the University, its officers, employees, agents or representatives of and from all claims, causes of action, costs, expenses, or demands which myself, my child, my heir, executors, administrators or assigns may have with respect to any such injury, death, loss or damage.

I CONFORM I HAVE READ, UNDERSTOOD AND ACCEPT THE ABOVE CONDITIONS.

Consent Form

I acknowledge that participation in athletics and recreation activities involves the risk of personal injury. In consideration of the use of the facilities, premises and equipment of Mount Allison University(“University”) by my child for athletics and/or recreation activities, I accept that risk, on behalf of my child, regardless of the nature of the injury. I agree and understand that the University, its officers, employees, agents and representatives shall not be liable for any personal injury, death, loss of property or damage as a result of my child’s participation in athletics and/or recreation activities at the University, whether caused directly or indirectly by the fault or negligence of the University, its offices, employees, agents or representatives or otherwise. I hereby release, indemnify and hold harmless the University, its officers, employees, agents or representatives of and from all claims, causes of action, costs, expenses, or demands which myself, my child, my heir, executors, administrators or assigns may have with respect to any such injury, death, loss or damage.

I CONFORM I HAVE READ, UNDERSTOOD AND ACCEPT THE ABOVE CONDITIONS.

Name of Child:

Name of parent/guardian (as a sign of agreement):

Date:

Name of Witness:

Phone Number of Witness:

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