Registration Form
Camper
Name:_____________________________
Address:________________________
City:________________________ State:________ Zip:________
Phone:( )_________________
E-Mail:_________________________________
Players responsible for own equipment [ Helmet & Shoulder Pads Only]
Emergency Contact Information
Name:___________________________
Relationship:______________________
Phone: ( )____________________
Insurance Carrier:_______________________
Policy Number:_________________________
Camp Location
Swansea, MA - Case HS ( )
Portsmouth, RI – Portsmouth HS ( )
Camp Options
Youth Grades 3-8: (1/2) Day_____ Full Day_____
High School ______
Position: Offense_________ Defense_________
Lunch: $35 ______ * Youth Campers Only
(5 Days)
Payment
½ Day Camper (Youth) $150 $___________
Full Day Camper (Youth) $195 $___________
High School Camper (1pm – 4pm) $___________
Lunch (Youth Only) $35 $___________
Total $___________
Make Checks or Money Orders Payable to East Bay Football Camp
Mail Payment to: Coach Monteiro - 16 Lilac Lane, Portsmouth, RI 02871
Cancellation & Refund Policy
Camp enrollment dictates the number of staff hired, equipment and facilities secured.
With this in mind, cancellations after thirty days prior to the start date of camp-$50
of your payment will be considered a non-refundable deposit.
Check In – Early Check In
Swansea – Early Check In Sunday
July 5th , 5pm to 6pm
Check In Monday, July 6th
AM / All Day Campers - 7:30 to 8:15 am
High School Campers – 12:00 to 12:45 pm
Portsmouth – Early Check In Sunday
July 19th, 5pm to 6pm
Check In Monday, July 20th
AM / All Day Campers – 7:30 to 8:15 am
High School Campers – 12:00 to 12:45 pm
Camp Disclaimer / Parental Release
I am the legal parent / guardian of the named camper who is a candidate to participate at the East Bay Football Camp. I recognize that there are risks associated with participation in the camp activities. I agree to assume all risks and responsibilities of my son/daughter’s participation in the East Bay Football Camp.
I agree not to hold the camp directors or coaching staff responsible in the event of an accident including but
not limited to an injury. I hereby authorize the EMT or Certified Athletic Trainer on staff to administer emergency treatment in the event of an accident or injury.
Signature:___________________________
Date:_____________
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