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      Sign up for Kirksville football camps in June and July

      2013 Kirksville Tiger High School Football Camp

      June 10- June 21, 2012 MWF

      Kirksville Senior High School

      PRE-REGISTERED COST: $ 30.00

      On-Site Registration $ 40.00





      Times: 7:30--10:30 a.m.



      Camp Staff will be the KHS Coaching Staff, and Alumni

      CAMP WILL COVER BASIC FOOTBALL FUNDAMENTALS:

      *** If inclement weather camp will be moved to KHS gymnasium:

      Registration Deadline: May 31, 2013 Forms Available at the KHS Office

      Or

      www.kirksville.k12.mo.us( click on high school page, athletics, and then football)

      PLEASE MAKE CHECKS PAYABLE TO KIRKSVILLE R-III School District

      FORMS CAN BE DROPPED OFF TO THE HIGH SCHOOL OR MAILED TO COACH JACQUES:

      JEFF JACQUES

      24595 EAGLE TRAIL

      KIRKSVILLE, MO 63501

      IF YOU HAVE QUESTIONS PLEASE CALL OR EMAIL :

      660-665-4631 EXT 3
      JJACQUES@KIRKSVILLE.K12.MO.Us

      CAMPER INFORMATION

      NAME:___________________________ Grade:________ 2012-2013

      Age:______ Birth date:___________ Position(s):_________

      ADDRESS:________________________________ CITY: ___________________ZIP:__________




      **IDENTIFICATION AND MEDICAL TREATMENT AUTHORIZATION**

      The undersigned parents and/or guardians of (campers name) ____________________, the applicant, for and in further consideration of the football camp acceptation said applicant, does hereby release and discharge Kirksville R-III Schools and itâ??s representatives, employees, and agents from any and all debts, claims, demands, actions, damages, caused of action, judgments, or suits of any kind which may arise or be occasioned as a result of any course of instruction or the applicants participation in the football camp. In addition, I/we being the parents and/or guardians of the applicant authorize the Kirksville R-III and itâ??s agents permission to request emergency medical treatment or care as necessary to insure the well being of our dependent. Further, I claim the registrant has had a physical examination in the past year and was found fit for all physical endeavors.

      Signature of Parent or Guardian:___________________________ Date:___________________

      Family Health Insurance provider:_______________________________

      Family Health Insurance policy #________________________________




      **Camper Code of Conduct Contract**



      2013 Kirksville Tiger High School Football Camp


      July 22- July26, 2013


      Kirksville Senior High School






      PRE-REGISTERED COST: $30.00 ($10.00 each additional sibling)



      ( includes Playerâ??s meal for Tiger Night )




      ON-SITE REGISTRATION: $40.00 ($10.00 each additional sibling)


      **Grades for 2013-2014 school year**



      Times: 7:30-10:30 a.m.







      Camp Staff will be the KHS Coaching Staff , , and Alumni






      CAMP WILL COVER BASIC FOOTBALL FUNDAMENTALS:



      *** If inclement weather camp will be moved to KHS gymnasium:






      Registration Deadline: May 31, 2012 Forms Available at the KHS Office







      Or








      www.kirksville.k12.mo.us




      ( click on high school page, athletics, and then football)





      PLEASE MAKE CHECKS PAYABLE TO KIRKSVILLE R-III School District




      FORMS CAN BE DROPPED OFF TO THE HIGH SCHOOL OR MAILED TO COACH JACQUES:





      JEFF JACQUES





      24595 EAGLE TRAIL





      KIRKSVILLE, MO 63501





      IF YOU HAVE QUESTIONS PLEASE CALL OR EMAIL :





      660-665-4631 EXT 3





      JJACQUES@KIRKSVILLE.K12.MO.Us




      CAMPER INFORMATION



      NAME:___________________________ Grade:________ 2013-2014







      Age:______ Birth date:___________ Position(s):_________







      ADDRESS:________________________________ CITY: ___________________ZIP:__________







      SHIRT SIZE (circle) YS YM YL ADULT: S M L XL XXL










      **IDENTIFICATION AND MEDICAL TREATMENT AUTHORIZATION**


      The undersigned parents and/or guardians of (campers name) ____________________, the applicant, for and in further consideration of the football camp acceptation said applicant, does hereby release and discharge Kirksville R-III Schools and itâ??s representatives, employees, and agents from any and all debts, claims, demands, actions, damages, caused of action, judgments, or suits of any kind which may arise or be occasioned as a result of any course of instruction or the applicants participation in the football camp. In addition, I/we being the parents and/or guardians of the applicant authorize the Kirksville R-III and itâ??s agents permission to request emergency medical treatment or care as necessary to insure the well being of our dependent. Further, I claim the registrant has had a physical examination in the past year and was found fit for all physical endeavors.


      Signature of Parent or Guardian:___________________________ Date:___________________


      Family Health Insurance provider:_______________________________


      Family Health Insurance policy #________________________________



      2013 Kirksville Tiger Middle School Football Camp


      July 22- July26, 2013


      Kirksville Senior High School






      PRE-REGISTERED COST: $30.00 ($10.00 each additional sibling)Grades 7-8



      ( includes Playerâ??s meal for Tiger Night )




      ON-SITE REGISTRATION: $40.00 ($10.00 each additional sibling)


      **Grades for 2013-2014 school year**



      Times: 9-11 a.m.







      Camp Staff will be the KHS Coaching Staff , , and Alumni






      CAMP WILL COVER BASIC FOOTBALL FUNDAMENTALS:



      *** If inclement weather camp will be moved to KHS gymnasium:






      Registration Deadline: May 31, 2012 Forms Available at the KHS Office







      Or








      www.kirksville.k12.mo.us




      ( click on high school page, athletics, and then football)





      PLEASE MAKE CHECKS PAYABLE TO KIRKSVILLE R-III School District




      FORMS CAN BE DROPPED OFF TO THE HIGH SCHOOL OR MAILED TO COACH JACQUES:





      JEFF JACQUES





      24595 EAGLE TRAIL





      KIRKSVILLE, MO 63501





      IF YOU HAVE QUESTIONS PLEASE CALL OR EMAIL :





      660-665-4631 EXT 3





      JJACQUES@KIRKSVILLE.K12.MO.Us




      CAMPER INFORMATION



      NAME:___________________________ Grade:________ 2013-2014








      Age:______ Birth date:___________ Position(s):_________







      ADDRESS:________________________________ CITY: ___________________ZIP:__________







      SHIRT SIZE (circle) YS YM YL ADULT: S M L XL XXL










      **IDENTIFICATION AND MEDICAL TREATMENT AUTHORIZATION**


      The undersigned parents and/or guardians of (campers name) ____________________, the applicant, for and in further consideration of the football camp acceptation said applicant, does hereby release and discharge Kirksville R-III Schools and itâ??s representatives, employees, and agents from any and all debts, claims, demands, actions, damages, caused of action, judgments, or suits of any kind which may arise or be occasioned as a result of any course of instruction or the applicants participation in the football camp. In addition, I/we being the parents and/or guardians of the applicant authorize the Kirksville R-III and itâ??s agents permission to request emergency medical treatment or care as necessary to insure the well being of our dependent. Further, I claim the registrant has had a physical examination in the past year and was found fit for all physical endeavors.


      Signature of Parent or Guardian:___________________________ Date:___________________


      Family Health Insurance provider:_______________________________


      Family Health Insurance policy #________________________________



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