2021 Brent Qvale Regional Football Camp

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Camper's First Name *

Camper's Last Name *

Camper's E-mail Address *

Home Address *

City *

State *

Zip *

Camper's Phone # *

Age *

Camper's age the day of the camp

Camper's School Name *

Grade in upcoming Fall *

Senior

Junior

Sophomore

Freshman

8th Grade

7th Grade

6th Grade

5th Grade

4th Grade

3rd Grade

Practice Jersey # *

Filming will occur during the camp which can be used for highlights video for the camper. Including the jersey will help to identify the camper.

Practice Jersery Color(s) *

Filming will occur during the camp which can be used for highlights video for the camper. Including the jersey color(s) will help to identify the camper.

T-Shirt Size *

XXL

3XL

4XL

Guardian's Name *

Guardian's Phone# *

Guardian's E-mail *

Insurance Company *

Policy Holder *

Policy Number *

Does the camper have any medical conditions coaches should be aware of? *

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