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2009 Brian Urlacher Football Camp
 July 1, 2, 3, 2008  9:30 AM-12:30 PM Ages 6-18
Lake Forest West Athletic Campus 300 S. Waukegan Rd. Lake Forest, Illinois 60045 847-433-8820 $225 per camper
$25 non-refundable deposit on all registration
Registration Form
Name: ____________________________________ Age: ______
Shirt Size: Adult: XL L M S XS or Youth: XL L M S Address: _____________________________________________ City: __________________ State: _________ Zip: __________ Phone #: ____________________ School: __________________ Email: _______________________________________________ Emergency Contact: Name: _______________________________ Relation: _______________ Phone #(s): ____________________ MANDATORY WAIVER, RELEASE AND INDEMNITY AGREEMENT
For and in consideration of the Brian Urlacher Football Camp as well as the Lake Forest High School and any department, organization or group affiliated therewith (collectively, “BUFC” and “LF”) permitting Participant to enroll in and participate in the Activity described above, participant, by signing below, hereby voluntarily indemnifies, releases from liability and holds harmless BUFC and LF for any accident, injury, illness, death, loss, damage to person or property, or other consequences suffered by Participant or any other person arising or resulting directly or indirectly from Participant’s participation in the Activity. In the event that Participant is injured, Participant agrees to assume any financial obligation, either through Participant’s personal health insurance, or through some other means, for any medical costs which Participant incurs. BUFC and LF assumes no responsibility for any medical expenses, injury, or damage suffered by Participant in connection with the use of any LF facilities or services in connection with the Activity. Participant further agrees to conform to all rules and regulations adopted by BUFC and LF relating to the Activity.
IT IS THE INTENTION OF PARTICIPANT BY SIGNING BELOW TO EXPRESSLY ASSUME ALL RISK OF PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE UPON HIM/HERSELF, TO THE EXCLUSION OF BUFC AND TU AND TO EXEMPT AND RELIEVE BUFC AND LF FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH.
Participant further agrees that Participant, his/her spouse, assignees, heirs, guardians, and legal representatives will not make any claim against, sue or attach the property of BUFC and LF for any loss or damage resulting from Participant’s participation in the Activity.
PARTICIPANT IS AWARE OF THE POTENTIAL DANGERS INCIDENTAL TO ENGAGING IN THE ACTIVITY, THAT THIS IS A RELEASE OF LIABILITY, A WAIVER OF THE PARTICIPANT’S LEGAL RIGHT TO COLLECT DAMAGES IN THE EVENT OF INJURY, DEATH OR PROPERTY DAMAGE AND A CONTRACT BETWEEN PARTICIPANT, BUFC, AND UNM AND PARTICIPANT SIGNS IT OF HIS/HER OWN FREE WILL.
Signature of Parent/Guardian: ______________________________________________________ $200 per camper until April 20, 2009
$225 per camper after June 20th
$250 after June 20th & for walk-up registration $25 non-refundable deposit on all registration
Mail Registration & Payments to:
Brian Urlacher Football Camp
643 Landwehr Rd. Northbrook, IL 60062
Questions: 847-433-8820
info@urlacherfootball.com |