Registration Form

First Name:

Last Name:

Age:

Grade in September:

Position:

School:

Coach:

Address:

City:

State:

Zip:

Email:

Home Phone:

Emergency Phone:

Camp:

Parent Name:

Restriction:

Insurance Name:

Insurance Number:

I agree to the following terms and conditions:

My son has permission to attend the Championship Defense Football Camp. I will be responsible for any medical or other charges in connection with his attendance at camp. I give my consent to the camp staff to authorize any medical treatment that may be needed for my child.

Payment Method: