2024 Blue & White Youth Football Camp

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Parent/Guardian Email *

Camper's First Name *

Camper's Last Name *

Grade (2024-2025 School Year) *

3rd Grade

4th Grade

5th Grade

6th Grade

Parent/Guardian First & Last Name *

Parent/Guardian Phone Number *

Payment $60 *

Venmo @Ryan-Smith-3148 (last four= 5063) camper's name in memo

Cash @ Camp

WAIVER STATEMENT: The undersigned states that he/she understands that Washburn Rural and the camp staff is not and shall not be responsible for or liable for any illness or injury to person or damage to property resulting from the program in which the undersigned is enrolling or being enrolled or from his/her participation in said program. The participant and the undersigned, if the participant is a minor or under other legal disability, hereby forever releases and holds harmless the said Washburn Rural camp staff, its employees, agents, and representatives from any and all claims of any kind that the participant, or the undersigned, or their respective heirs, executors, administrators, or assigns may have or claim to have resulting from participation in said program. I HAVE READ AND UNDERSTAND THE WAIVER STATEMENT (electronic signature):

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