First Name   Last Name

  Parent/Guardian Full Name

  Street Address

  City   State   Zip

  Email

 Home Phone

  Position:  Quarterback  Wide Receiver Tight End

  Grade in Fall of 2009 (Must Be Entering at least 7th Grade) Check one:

 7th     8th     9th    10th    11th    12th

  Birth Date (xx/xx/xxxx) 

  T-Shirt Size SM  MED LG XL

  School Name

  Head Coach Name

Resident Camper $275       Commuter Camper $250

Two or More Resident Campers from the same school  $250.00

Two or More Commuter Campers from the same school  $225.00

  If Resident Camper: (Reminder each student must fill out their own application)

  1. Preferred Roommate Name (Full Name)

  1. Roommate's School Name

  2. Preferred Roommate Name (Full Name)

  2. Roommate's School Name

  3. Preferred Roommate Name (Full Name)

  3. Roommate's School Name

PARENT/GUARDIAN EMERGENCY CONTACT INFORMATION

  Emergency Contact Name

  Relationship to Camper Parent Legal Guardian Other

  Cell Phone   Home Phone

  Work Phone

  Please be sure all information is correct before you hit submit.