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| TRAINING | ||||
| RAMS
YOUTH FOOTBALL CLINIC
PROGRAM
DIRECTOR: Lou Silva, Head Coach, MHS Rams Send
completed form to: LOU SILVA, 32 COUNTRY WAY, MARSHFIELD, MA 02050 NAME:________________________________________ DATE OF BIRTH:__________________ ADDRESS:______________________________________STATE:______ ZIP:_______________ HOME PHONE:___________________________________CELL PHONE:___________________ GRADE (09-10):______________SCHOOL:__________________________________________ INSURANCE COMPANY & PLAN NUMBER:____________________________________________ POSITION: OFFENSIVE_______________DEFENSIVE___________________ I accept full responsibility for my child's use of all apparatus, appliances, or service whatsoever, owned and operated by this clinic, its director, representatives, and agents and hold the clinic harmless form any and all loss, claim, injury, damage, or liability sustained or incurred by me resulting there from. PARENT SIGNATURE:___________________________________________________________ | |||
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