*Participants Name:

*Address:

*City:

*State:

*Zip:

*Participants Cell Phone:

*Home Phone:

Grade:

*Email:

*School:

*Head Coach:

*Coach Phone:

*Coach Email:

Select a position: Kicker Punter Kicker & Punter Holder

Select Camp(s):
Lehi, UT: June 24-25, 2011
Castle Rock, CO: June 18-19, 2011
Spearfish, SD: July 9-10, 2011
Laramie, WY: July 16-17, 2010
Private Camp

If you chose private camp, please enter a date that would be good for you. (mm/dd/yyyy)

Mail Check/Money Order payable to:
On-The-Line Specialty Camps
205 Washington St.
Spearfish, SD 57783

*There are no refunds, however, you can change camp dates.

WAIVER AND RELEASE OF CLAIMS:
In consideration of my attendance at the program run by the company and other good and valuable consideration, the sufficiency of which is hereby acknowledged, I * for myself, my heirs, and administrators fully, and unconditionally release On-The-Line Specialty Camps and the States of Wyoming, South Dakota, Utah, Colorado and it's officers, directors, employees, shareholders, representatives, sponsors and affiliates from any and all liability for death, disability, personal injury, property damage, property theft, or actions of any kind, which may hereafter accrue to the User. I also release On-the-Line Specialty Camps, LLC and its employees from any claims arising out of the minor's participation in the program.

INFORMATION RELEASE PERMISSION:
I agree that by submitting this form, On-The-Line Specialty Camps may use the personal information disclosed therein for the purpose of college recruiting and the same may be released to individuals in the recruiting and/or athletic testing and evaluation business as well as to other high schools and college football programs. I understand that participating in a On-The-Line Specialty Camps program does not guarantee any financial aid or scholarship money.

By entering your name here you are providing an electronic signature which will take place of a written signature.