Spring 2024 - Niles West High School Football Youth Clinics
All participants must be registered in advance in order to attend any youth clinic sessions. All Youth clinic participants must live within District 219 Boundaries.  These clinics are FREE & open for students currently in grades 7 and 8. 
Any Questions, please contact Coach Anastasiadis: kyrana@d219.org
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Spring 2024  Youth Clinic Details
* All sessions are from 1:00 to 2:30 PM *

Dates & Clinic Locations Below:
- Sundays April 7, 14, 21, 28
- Sundays May 5 & 19

Location: 
- Fieldhouse and/or Fields
Student First Name *
Student Last Name *
Current Grade Level for the 23-24 School Year *
Current School You Are Attending (*District 219 youth clinics/camps are only for students within District boundaries) *
Medical Information: Please list known medical conditions, allergies, health modifications, current medications taken, and any information that would assist in the event of a situation or emergency *
Parent Full Name *
Parent Cell Phone Number *
Parent Email Address *
Second Emergency Contact - Full Name *
Second Emergency Contact - Cell Phone Number *
PARENT CONSENT FOR PARTICIPATION, WAIVER & RELEASE
Please read this section carefully and be aware that participation in the athletics/activities for which your child is being registered entails, like participation in all recreational activities, certain risks which cannot be entirely eliminated despite due care exercised by Niles Township High School District 219 staff in conjunction with  such program(s).

I hereby give my consent for my child to participate in the athletic/activities summer camps.  I understand that appropriate precautions are taken to protect program participants.  However, I also recognize and acknowledge that there is a degree of risk that my child may sustain personal injury, illness or damage to property in the course of partaking in such activities including transportation, and that Niles Township High School District 219 cannot guarantee risk-free recreational experiences to program participants.  I further acknowledge that my child could be exposed to someone who may be incubating communicable illnesses or other diseases, including but not limited to COVID-19 (Coronavirus), and who may be capable of spreading disease to others during participation. I nonetheless desire to procure the benefits of recreation for my child, and accordingly consent to his/her participation in the athletic/activity and agree to assume any and all risks and dangers associated with his/her participation.

I agree to notify Niles Township High School District 219 in writing if I opt to arrange non-district transportation for my child for any and all practice, event, or competition.  

I agree to emergency treatment of my child by a District 219 Athletic Trainer, third party trainer, physician or hospital in the event I cannot be reached, and I understand that Niles Township High School District 219 does not cover or insure participants for any types of medical costs. I agree to inform District 219 of any relevant medical information at the time of enrollment and prior to my child’s participation.

I hereby fully release and discharge Niles Township High School District 219 and its officers, agents, servants and employees from any and all claims for injury, illness, disease, damage, loss or death which I may have or which may accrue on account of my child’s participation in the program(s).  I further agree to indemnify and hold harmless Niles Township High School District 219 and its officers, agents, servants and employees from any and all claims and expenses, including attorney’s fees, resulting from injury, illness, disease, damage, loss or death sustained and arising in any way out of my child’s participation in said programs.

Media Consent: I understand that names and pictures of my son/daughter, in the role of a participant in an extracurricular activity may appear in rosters, programs, and the media including newspapers, television, radio, the Internet, and social media, and I agree to the release of the same as a condition of his/her participation in an extracurricular activity in District 219.

By typing my full name in the box below, I am signing this Agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. I consent to be legally bound by this Agreement's terms and conditions.
Parent//Guardian Signature for Completion *
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