FOR HIGH SCHOOL TEAMS! DATE: SATURDAY, JUNE 23rd, 2018 REGISTRATION: 8:00AM COST: $250/PER TEAM* The 7-on-7 Team Passing Camp at Rutgers is a one-day passing camp. The Team Passing Camp is an excellent way for high schools to compete against the finest teams in the STATE OF RUTGERS! The first 72 COMPLETE packets we receive will be guaranteed a 7-on-7 spot. Field Availability is limited this year, so walk up teams on day of event may be turned away. Make sure you mail in your complete packets ahead of registration day by June 14th! $250-20 Players per Team* $20.00 for each additional player (up to 5 players only) 1 TEAM PER HIGH SCHOOL (2 nd Team Permitted if Availability in Brackets) THIS PACKET INCLUDES: l 1 Team Registration Form and Checklist l 1 Team Roster *Please mail your completed registration packet and payment to: CHRIS ASH FOOTBALL CAMP RUTGERS FOOTBALL ONE SCARLET KNIGHT WAY, PISCATAWAY, NJ 08854 PH 732-445-6200 FAX 732-445-5128
TEAM REGISTRATION FORM HEAD COACH FULL NAME COACH EMAIL COACH CELL PHONE # HIGH SCHOOL NAME ADDRESS CITY ST ZIP NAME OF COACH ACCOMPANING TEAM (if other than head coach) # OF CAMPERS ATTENDING CHECKLIST Please include the following items with your registration packet: o Payment $250.00/per 20 Man Team ($20/additional player up to 5 players) Payment Method: Check o Money Order o Credit Card o Name on Credit Card: Credit Card #: CVV # Cardholder Signature: Cardholder Zip Code: Exp. Date: Type of Credit Card: MasterCard Amex Discover Visa Please make checks and money orders payable to: Chris Ash Football Camp **PLEASE NOTE, NO REFUNDS!** o Roster o *Participant Applications Completed and signed by Parent/Guardian o *Medical Information Forms Completed and signed by Parent/Guardian Mandatory for each participant *NOTE TO COACHES: Each Participant s Application & Medical Information Form must be completed and signed by his Parent or Legal Guardian in order to participate in Team Passing Camp.
PARTICIPANT APPLICATION *CAMP PARTICIPATION IS PROHIBITED unless this form is completed & signed by the camper s PARENT / LEGAL GUARDIAN* NAME: HOME PHONE: ADDRESS: CITY: ST: ZIP: SCHOOL: GRADE (FALL 2018): EMERGENCY CONTACT: WORK OR CELL #: Informed Consent: In consideration of being permitted to participate in any way in the Rutgers Football Team Passing Camp the parent(s) and/or legal guardian(s) of the minor participant named below agree: I am fully aware and thoroughly informed of the hazards of participating in a football camp; further, I have read and fully understand the following: That participation is voluntary and at my/minor s own risk; That a Football Camp is a physical activity involving heavy exertion. A camp participant must be in good general health, free from cardiovascular and respiratory disease, or other diseases or ailments and have good exercise tolerance; That while participating in a Football Camp the human body is subject to a variety of influences that may become potentially hazardous. Some of these hazards include, but are not limited to, severe head injury and a variety of other bodily injuries such as broken bones, including the potential for permanent disability and/or death; Notwithstanding these risks, for and in consideration of the minor s participation, I, for myself, the minor and the minor s assigns and heirs do waive, release and discharge Rutgers Football Camp, Rutgers, The State University of New Jersey and their governors, trustees, officers, employees and agents from any and all claims, demands, actions, causes of actions, costs and expenses for and by reason of any personal injury, property damage, loss and expense, which heretofore have been or hereafter may be sustained or suffered by the minor in consequence of and as a result of a certain accident, casualty or event or the minor s presence or activities in connection with this football camp. I also agree to indemnify and hold harmless Rutgers Football Camp and Rutgers University for injuries sustained either by the minor and/or caused by the minor to others during the football camp. Furthermore, I acknowledge that the risks outlined above are not intended to be all- inclusive and voluntarily accept all risks known or unknown. Medical Release: I hereby authorize the clinical staff of University Health Services, Rutgers Sports Medicine, and UMDNJ/Robert Wood Johnson University Hospital to provide emergency medical treatment as necessary to my son/daughter. I understand that the consent and authorization herein granted may include routine diagnostic procedures (i.e. Xrays, blood and urine tests) and are valid only during camp. Rutgers, The State University of New Jersey, is not responsible or liable for any of the activities in respect to the camp; the Camp Director is an independent contractor. The camp director reserves the right to cancel or postpone any activity due to insufficient enrollment or other unforeseen circumstances. SIGNATURE REQUIRED: (Parent/Guardian s Signature) DATE: (Parent/Guardian s Printed Name)
PLAYER MEDICAL INFORMATION CAMP PARTICIPATION IS PROHIBITED unless this form is completed & signed by the camper s PARENT / LEGAL GUARDIAN* Camper s Name: Camp Attending: Date of Birth: Height: Weight: *HEALTH INSURANCE CARRIER: POLICY #: *All medical costs not covered by personal insurance are the responsibility of the participant / parent. Physician s Name: Physician s Phone #: Has camper ever been withheld by a doctor from participating in sports activities?! YES! NO If yes, when? Explain condition: Medications camper is taking: Allergies: *Food / Drug / Other: *Campers with serious dietary restrictions are advised to bring their own lunches. Other medical or physical conditions we should be aware of: Immunizations against Diphtheria, Tetanus, Poliomyelitis, Measles, Pertussis, Mumps and Rubella are required. Chapter 375 P.O. 1973 New Jersey Youth Camp Safety Act Standards 8:25-3.3: All campers shall be immunized or shall provide a statement from a physician that immunization is in progress. The Official Immunization record must be available upon request. I certify that my son/daughter has had a medical examination within the past 12 months and has been found in satisfactory health and free of disease. There are no apparent contra-indications to participating in football camp activities. By signing this statement, I certify that the above information is true and I agree to take full responsibility for costs incurred due to any injury or sickness which may occur to the participant during camp. Parent/Legal Guardian Signature: Date: Parent/Legal Guardian Printed Name:
1. ROSTER FORM PLEASE LIST ALL PLAYERS THAT WILL BE ATTENDING. Minimum Players: 12 Maximum Players: 20-25 NAME *A completed Player Application is required for each participant GRADE as of Fall 2018 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.