Statesmen Football

Monday–Tuesday • June 5–6, 2017

William Penn University • Oskaloosa CampusPenn Activity Center (PAC)

Cost: $45 if pre-registered* • $55 day of camp

Instruction will include learning the fundamentals of all football positions. Wear appropriate shoes and clothing.*No refunds given if pre-registered*

To register, please complete the form below and return to: Todd Hafner, WPU Athletics Department • 201 Trueblood Avenue • Oskaloosa, Iowa 52577 or call 641-673-2160.

STUDenTS gOIng InTO grADeS 1–4 9:00 Am–12:00 Pm

STUDenTS gOIng InTO grADeS 5–8 1:00 Pm–4:00 Pm

As a parent or legal guardian of_________________________, I hereby give my consent for his/her participation in the Statesmen Football Summer Youth Camp. I understand William Penn University, Todd Hafner, and his coaching staff are not responsible for any injury that may occur during the camp. I further understand football is a strenuous sport requiring good physical conditioning. In case of an emergency, Todd Hafner or a William Penn University employee may seek emergency treatment.

_______________________________ __________________________ _____ ___________________________ Parent/Guardian Name Athlete’s Name Grade Emergency/Cell #

Please circle YS YM YL AS AM AL Make checks payable to: Statesmen Footballt-shirt size: 6–8 10–12 14–16 32–34 36–38 40–42 media & Photo release

I (choose one) hereby □ consent or □ do not consent to the use of my son’s or daughter’s name and/or photograph for publicity and promotional purposes by William Penn University (including Internet, print and broadcast media).

Parent or Legal Guardian’s Signature _________________________________________________________________________

Statesmen Football Summer Youth Camp registration Form

SUmmer YOUTH CAmP