Red Land Patriot Football Camp Registration

Mail this form in as soon as possible. We will also accept some campers the first night of camp, but make sure you get there early!!

NAME: _____________________________________________

ADDRESS: __________________________________________

CITY: _____________________________________________

PHONE: ____________________________________________

AGE: ____________

I, the parent/guardian of ______________________________________ give him/her the permission to participate in the Patriot Football Camp and hereby, for ourselves and the above-named child in our care, release and hold harmless and forever discharge Red Land Midget Football and all instructors for said program from all present and future claims, demand, action, or suits arising from or any way related to said program

________________________________________________________________
Parent/Guardian Signature

____________________________________
Date Signed

Please make checks payable and mail to:

Red Land Midget Football
P.O. Box 129
Lewisberry PA 17339

Questions? Please call Larry Cox at (717) 932-3912.