Registration

* Fill out and return by June 1

June 9^th – June 12^th

1pm – 4pm

Last name _________________________

First name _________________________

DOB _______ Tee shirt size _________

Address ___________________________

___________________________

Phone # ___________________________

Parent’s name _____________________

Emergency Phone # _________________

School ____________________________

Email address ______________________

Insurance Provider __________________

Insurance Policy # __________________

Waiver: My child has my permission to attend the Lexington Catholic Youth Football Camp. I certify that my child has been examined by a licensed physician within the last 12 months, and is able to participate in all football camp-related physical activities. I agree to assume any and all risks associated with my child’s participation in the Lexington Catholic Youth Football Camp. PARENT SIGNATURE: Date:

Return to: Lexington Catholic Football

2250 Clays Mill Road

Lexington, KY 40503