21st CPA Flag Football Summer Sports Clinic                   
Summer Flag Football Skills Clinic (Girls + Boys) @ Villela Park: 3400 Monroe St NE Albuquerque NM 87110  
-  Start Date: June 20, 2023
-  End Date: June 22, 2023

Location:     Villela Park (3400 Monroe St NE, Albuquerque, NM 87110)

Grade Range: Incoming 1-8th Grade  (Public is welcomed)
                                           **LIMITED SPACES**

Event Fee:   $5 ea. athlete/clinic
                                 **Cash, check, or Money Order (Payable to 21st CPA) 

 Registration Closes:    Tuesday, June 20 , 2023        

Event Description:
  • June 20-22 (Tuesday-Thursday) 3- Day Clinic@ 4:30-6:00p
  • Walk- Up Registration (Day of Clinic) = (If Available)
  -Child must be registered prior to participating in event. Registration fee due prior to athletes participation.

The 21st Century Public Academy Football Skill Clinic aims to enhance the basic and advanced skills of every athlete who joins. All players, regardless of their level, are invited to participate in the events that can help improve their skills, confidence, and player IQ. The camp will be led by the 21st Century Coaching Staff, current and former 21st CPA players, and Local Community Guest Speakers. 

Proceeds from the camp will benefit the 21st Century Public Academy Athletic Program.

For more information or details of events please contact: Dana "DA" Alexander at dalexander@21stcenturypa.com
Email *
Flag Football Required Apparel and  Equipment:
Below is a suggested list of clothes, equipment, and personal items. 21st CPA Camps are NOT responsible for lost or stolen articles or money.
-Water bottle (Name Labeled)
-Football Cleats (No Metal) or Running Shoes 
-T shirt and Athletic Shorts/Pants
-Mouthpiece
-Medical Devices (Braces, Inhaler, etc.)
-Football (Name Labeled) (Optional)
Summer Camp Events
Child's Information
Child's First Name: *
Child's Last Name: *
Child's Birth Date including year: (mm/dd/yyyy) *
Does your child have asthma? *
Does your child have any severe allergies to food or medications?
Leave the space "Blank" if this question does not relate to your child.
Does your child have any other important medication conditions we should know about?
Leave the space "Blank" if this question does not relate to your child.
Child's Grade in Fall 2023-2024:
Athletes Grade *
Is your child a current 21st Century Public Academy student? *
Parent's Information
First Name: *
Last Name: *
Home Phone: *
Cell Phone: *
Email Address: *
Relationship to child: *
Emergency Contact Information with Authorization to Pick Up:
List two individuals other than parent/legal guardian to be contacted in case of emergency; must be local and have permission to pick up your child.
1st Emergency Contact Name: *
Phone Number: *
2nd Emergency Contact Name: *
Phone Number: *
Waivers- (Required for participation)
21st Century Release Waiver:  
21st CPA COVID- 19 Waiver Disclaimer
Parent(s)/ Guardian(s) acknowledge that they have carefully read the above Elementary Skills Clinic Release and COVID-19 Waiver Disclaimer and that they agree to its terms. *
Concussion In Sports (Fact Sheet)-  https://www.nmact.org/file/Facts_4_Families.pdf
Click the above web address (URL) to preview.
Parent(s)/ Guardian(s)  and student-athlete agree to the NMAA Concussion Fact Sheet for Athletes & Parents? *
I understand while participating in this activity, my (child/participant) may be photographed. I agree to allow my (child/participant) photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. *
Type in your Full Name below:  Signature *
It is understood that you (Parent/Guardian) read and have agreed to all terms within the Release Waiver, COVID-19 Waiver,  Photo Release Waiver and Concussion Fact Sheet Document, by typing your full name in the space below.
Note:   
There will be no refunds given once clinic, camps, or competitions starts.  There will be no refunds if a child becomes sick or injured during clinics, camps, or competitions.  Each participant will only receive one T-shirt for their participation in the 2023 21st Summer Camp season, even if they attend multiple 2023 21st Summer Sports Camps.
Time and dates may/can change due to facility availability, weather, or unforeseen circumstances.  
A copy of your responses will be emailed to .
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