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      Sign up for 2013 Kirksville football camp

      2013 Kirksville Tiger High School Football CampJune 10- June 21, 2012 MWFKirksville Senior High School

      PRE-REGISTERED COST: $ 30.00On-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 OfficeOr www.kirksville.k12.mo.us( click on high school page, athletics, and then football) PLEASE MAKE CHECKS PAYABLE TO KIRKSVILLE R-III School DistrictFORMS CAN BE DROPPED OFF TO THE HIGH SCHOOL OR MAILED TO COACH JACQUES:JEFF JACQUES24595 EAGLE TRAILKIRKSVILLE, MO 63501IF YOU HAVE QUESTIONS PLEASE CALL OR EMAIL :660-665-4631 EXT 3JJACQUES@KIRKSVILLE.K12.MO.UsCAMPER INFORMATIONNAME:___________________________ 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 it'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 it'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 Player'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 it'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 it'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 Player'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 it'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 it'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 #________________________________