2015 RUTGERS FOOTBALL CAMP APPLICATION
REGISTER AND PAY ONLINE! IT’S QUICK AND SECURE! FOOTBALLCAMP.SCARLETKIGHTS.COM
CAMPER INFORMATION
NAME:
GRADE Fall 2015:
SCHOOL:
POSITION (Circle one only): DB DL LB OL QB RB TE WR
CAMPER EMAIL:
HOME STREET ADDRESS:
SHIRT SIZE: S M L XL XXL
BIRTHDATE:
CITY:
STATE:
ZIP:
CAMPER CELL:
PARENT/GUARDIAN INFORMATION
NAME:
PARENT’S EMAIL:
PARENT’S CELL #:
EMERGENCY CONTACT NAME:
PHONE #:
HEALTH INSURANCE CO:
HOME #:
RELATIONSHIP TO CAMPER:
POLICY #:
GROUP#:
INSURANCE WAIVER if participant is NOT covered by insurance, you must sign the following agreement:
I will take full responsibility for all uncovered medical expenses incurred by the participant during camp._____________________
Signature of Parent/Guardian
KNIGHT SKILLS
CAMP
BIG MAN
ACADEMY
JUNIOR VARSITY CAMP
REGISTER ONLINE OR
MAIL APPLICATION,
PHYSICAL FORM, AND
PAYMENT TO:
(QBs, RBs, WRs, TEs, LBs, & DBs)
(OL, DL)
Entering Grades
Entering Grades
Camp Registration Fee
$80 per date
th
9 -12
th
th
th
KS2
Sat.,June 20th
3PM- 10PM
8AM- 3PM
Registration Due Date:
If by Mail
Due by
05/ 27
BMA1
Sat., June 6th
BMA2
Fri., June 19th


Due by
05/28
Due by
06/10

Due by
06/11
8AM- 3PM
Entering Grades
3PM- 10PM
Entering Grades
th
th
6 -8
9 -12
$80
$110
Wednesday,June 24th
Wednesday,June 24th


Due by 06/16
Due by 06/16
th
$80 per date
KS1
Fri., June 5th

(Kickers, Punters and Long Snappers)
9 -12
RUTGERS FOOTBALL CAMP
One Scarlet Knight Way
Piscataway, NJ 08854
SPECIALISTS
CAMP
th
7:45AM-3PM
8AM-5PM
TYPE OF CARD
PAYMENT INFORMATION
CREDIT CARD #
CHECK# __________ AMOUNT $_____________
Make payable to Rutgers Football Camp
OR Charge Credit Card listed to the right

EXP. DATE: ____
______
CVV:
CARD HOLDER ZIP___________
NAME ON CARD:
SIGNATURE:
PARENT/GUARDIAN SIGNATURE REQUIRED
In consideration of being permitted to participate in any way in the Rutgers Football Camp the parent(s) and/or legal guardian(s) of the minor participant named below agree:
I am fully aware and thoroughly informed of the hazards of participating in a football camp; further, I have read and fully understand the following:
•
That participation is voluntary and at my/minor’s own risk;
•
That a Football Camp is a physical activity involving heavy exertion. A camp participant must be in good general health, free from cardiovascular and respiratory disease, or other
diseases or ailments and have good exercise tolerance;
•
That while participating in a Football Camp the human body is subject to a variety of influences that may become potentially hazardous. Some of these hazards include, but are
not limited to, severe head injury and a variety of other bodily injuries such as broken bones, including the potential for permanent disability and/or death;
Notwithstanding these risks, for and in consideration of the minor’s participation, I, for myself, the minor and the minor’s assigns and heirs do waive, release and discharge
Rutgers Football Camp, Rutgers, The State University of New Jersey, and their governors, trustees, officers, employees and agents from any and all claims, demands, actions,
causes of actions, costs, and expenses for and by reason of any personal injury, property damage, loss and expense, which heretofore have been or hereafter may be sustained
or suffered by the minor in consequence of and as a result of a certain accident, casualty or event or the minor’s presence or activities in connection with this football camp. I
also agree to indemnify and hold harmless Rutgers Football Camp and Rutgers University for injuries sustained either by the minor and/or caused by the minor to others during
the football camp. Furthermore, I acknowledge that the risks outlined above are not intended to be all-inclusive and voluntarily accepts all risks known and unknown.
Medical Release:
I hereby authorize the clinical staff of University Health Services, Rutgers Sports Medicine, and UMDNJ/Robert Wood Johnson University Hospital to provide medical care that
includes routine diagnostic procedures (i.e. x-rays, blood and urine tests) and medical treatment as a necessary to my minor son/daughter. I understand that the consent and
authorization herein granted do not include major surgical procedures and are valid only during camp.
Rutgers, The State University of New Jersey, is not responsible or liable for any of the activities in respect to the camp; the Camp Director is an independent contractor. The camp director
reserves the right to cancel or postpone any activity due to insufficient enrollment or other unforeseen circumstances.
Date
Print Parent/Guardian’s Name
Signature of Parent/Guardian
Date
Print Participant’s Name
Signature of Participant