Benedictine College Preparatory football summer camps

Middies One Day Football Camp 2025

Child's First Name*

Child's Last Name*

Child's Gender*

Projected H.S. Graduation Year*

Current Grade

Age as of 7/31/2025*

Current School in Fall 2025*

Parent First Name*

Parent Last Name*

Parent Email*

Phone Number*

Street Address*

City*

State/Region*

Postal Code*

Country/Region

Guardian's address, phone, email if different

Health Insurance Coverage and Subscriber's Name*

NOTE: Evidence of a physical examination by each player's primary care physician is required prior to the first day of summer camps.

Does player have any physical disabilities or other conditions that may affect his ability to play football? If so please list*

Player's Current Height*

Player's Current Weight*

How many years have you played this sport?*

For What Team?*

What position do you play or are you interested in playing?*

Emergency Medical Treatment

NOTE: By signing this form the parent/guardian is giving permission for their child to participate in the Saint Gertrude High School summer camps and consents to emergency medical treatment.

I, the parent/guardian, authorize and consent to emergency medical and/or non-emergency minor first aid treatment for my child/ward while enrolled as a participant in a Saint Gertrude High School Summer Camp. The Athletic Director, the Benedictine School of Richmond's athletic trainer, and personnel have my permission, in an emergency when I cannot be contacted, to take my child/ward to receive treatment that a physician deems necessary for the well-being of my child/ward. (If there is an objection to seeking emergency care, a statement should be provided by the parents/guardians that states their objection and the reason for objection.)

I Agree

Waiver/Release of Liability Hold Harmless Agreement*

I understand that there is risk inherent in any sporting activity. I certify that my child is in good health and fully able to participate in the summer camps. My child is covered by medical insurance. In consideration of being allowed to enroll in The Benedictine College Preparatory Summer Camps, the participant and the parent or guardian of the participant do hereby agree for ourselves, our heirs, executors and administrators to release, hold harmless and forever discharge the Athletic Director, the Benedictine School of Richmond's athletic trainer, the employees, coaches, students, and affiliates against any and all claims, actions, causes of actions, suits, judgments, and demands whatsoever arising directly, or indirectly, in connection with the participant’s association with or participation in Benedictine College Preparatory Summer Camps. By signing below and agreeing to the terms set forth, I acknowledge that I have read and understood this form and further understand that the terms herein are contractual and not mere recital.

I Agree

Parent/Guardian Electronic Signature*

Middies One Day Football Camp 2025 $20*