Spartan Sports Camps (Football Prospect Camp)

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Date: Saturday July 16, 2022
Time: 9am-12pm
Cost: $85.00 (No refunds after July 1, 2022)
Location: DiSanto Field (CWRU Campus)
Address: 1647 E. 118th Street
Cleveland, Ohio 44106

Email *

Full Name *

Birthdate *

YYYY

Player's Cell Phone # *

Address *

Player's Email Address *

Parent/Guardian Email Address *

High School *

Graduation Year *

Offensive Position *

Defensive Position *

Preferred College Position *

GPA *

ACT/SAT Score

T-Shirt Size *

Medical Authorization: Minor Name *

Name of Parent or Guardian *

I, being the parent or legal guardian of the above name do hereby certify that my son/daughter has been checked by a physician, is in good health, and I consent to my son/daughter's participation in all football camp activities. I further verify that my son/daughter is covered by health and medical insurance. I understand that participation in football camp has inherent risks of injury and I release Spartan Sports Camps, Case Western Reserve University, their employees, officers, and agents from liability or damages that may occur from participation in the football prospect camp. I hereby appoint the Spartan Sports Camps staff to act on my behalf in authorizing medical attention. *

I agree to the above statement

Required

Date *

YYYY

Insurance Provider *

ID or Contact Number *

Emergency Contact and Relation to Athlete *

Emergency Contact Phone #(s) *

Emergency Contact #2 and Relation to Athlete *

Emergency Contact #2 Phone #(s) *

Allergies (please list) *

Current Prescription Medications the participant is currently taking *

Past Injuries or Ailments *

Your child’s safety is our top priority. If you suspect or see child abuse or neglect, please report it to authorities in one of the following ways:CWRU Division of Public Safety (24-hour number is 216.368.3333); you may remain anonymous.Youth Program DirectorCWRU Youth Programs Compliance Coordinator, Carissa Tuliraba cxt347@case.edu or 216.368.4489CWRU Integrity Hotline 866.483.9367 or go to caseintegrityhotline.com *

I have read and understand this policy

Required

Are you planning to stay for the Campus Tour

Yes

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