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2. football

Clark Brothers Football Camp
July 11-12, 2015
Welcome to the 2015 Clark Brothers Football Camp!
The Clark brothers (Dan, Derrik & Dallas) of Livermore, Iowa have all played football at college
level or higher and are excited to come back home for this annual football camp. Each year the
Clark brothers team-up to help student-athletes (7th to 12th grade) who want to learn the
fundamentals of football and provide them the tools to gain a competitive advantage on the
playing field.
Featuring some of the most talented names in college and professional football, Dan, Derrik
and Dallas thought it would be a great idea to ask their friends and former college teammates
to help teach the necessary fundamentals of football. This year we are proud to announce the
Clark Brothers Football Camp coaching lineup:
Dan Clark, Simpson College
Derrik Clark, Waldorf College, University of Iowa State, Carolina Panthers
Dallas Clark, University Iowa, Indianapolis Colts, Tampa Bay Buccaneers, Baltimore Ravens
Rob Bloomster, Waldorf College
Brett Heitland, Simpson College
Mark Kacrmarynski, Central College, Chicago Bears, Philadelphia Eagles, Indianapolis Colts
Andy Lightfoot, University Iowa
Kyle McCann, University of Iowa, New York Jets
Bruce Nelson, University of Iowa, Carolina Panthers
Brent Parrott, Simpson College
Nick Thummel, Waldorf College, University of Iowa
We look forward to teaching you the fundamentals of football, providing you with key insights
learned over the course of many years, and to give you the opportunity to become the best
football player you can become.
Sincerely,
Dan, Derrik & Dallas Clark
Clark Brothers Football Camp
July 11-12, 2015
The Clark Brothers Football Camp focuses on teaching athletes the skills and fundamentals to
play football at a higher level.
WHO: Grades 7-12 (going into 7th grade).
WHERE: Humboldt High School (practice fields behind the high school).
WHEN: Saturday & Sunday July 11-12, 2015 (Saturday: 9am-1pm and Sunday: 1pm-5pm).
WHY: Teaching the skills and fundamentals to play the game of football at a higher level.
BRING: Shorts, Shirt, and Football Cleats.
COST: $25/Camper. Please make checks payable to: Dallas Clark Foundation (no cash please).
*Every camper receives a T-Shirt
Clark Brothers Football Camp
July 11-12, 2015
REGISTRATION FORM
NAME: ___________________________________________________________________
SCHOOL: _________________________________________________________________
GRADE (for 2015/16): ________
SHIRT SIZE: _______ POSITION (current or desired): _____________________________
Release of Liability
In consideration of being permitted to participate in the Clark Brothers Football Camp, I hereby release all the
coach's and The Dallas Clark Foundation from any and all liability or claims relating to any bodily injury or
property damage that may be sustained by the camper while attending and/or being transported to or from
the camp.
I hereby authorize and give my consent to the staff of the camp to act on my behalf to secure medical
treatment for the administration of all emergency medical treatment. I understand that should an emergency
medical problem arise, an attempt will be made to contact me. In the event that I cannot be reached, I hereby
give consent to such treatment as deemed necessary by a licensed health care professional.
I agree to assume all cost related to such treatment. I understand that I will be responsible for any medical or
other charges in connection with attendance at this camp.
Parent's/Guardian Signature ____________________________________Date_____________
Parent's/Guardian Name (print)___________________________________________________
Address_____________________________________City_________________Zip___________
Name and Emergency Phone #____________________________________________________
Insurance Company_____________________________________________________________
Insurance Company address______________________________________________________
Policy No._____________________________________________________________________
By filling this registration form out and signing I AGREE to the terms of Above.
NOTE: Please bring along this registration form and check made out to The Dallas Clark Foundation
for the amount of $25 per camper on the first day of camp.