Todd Bates Football Camp

Todd Bates Football Skills Camp held May 10th at the Heflin Recreation Center--City Football Field. Information and Sign-up Sheet (inside).

Todd Bates Football Skills Camp May 10th

HEFLIN RECREATION CENTER – CITY FOOTBALL FIELD
AGES 6-12: 8:30am-2:30pm
AGES 13-18: 12:30pm-6:30pm
COST: $40
for a copy of the group photo add $5

Event Coaches:

Freddie Roach Alabama Linebacker 10th All-Time Tackler UA History
Charles Jones Alabama Defensive Back 2nd Team All-SEC
Brandon Brooks Alabama Kick Return/WR Track and Field Record Holder
Deon White Jacksonville State Offensive Line JSU Hall of Fame & All-American

Todd Bates Alabama Defensive Line Permanent Team Captain 2004
Arsenio Hayes Jacksonville State Wide Receiver Defensive Back
Juwan Simpson Alabama Linebacker 2nd Team All-SEC
Matt Miller Alabama Quarterback/WR All-Area High School
Darius Gilbert Alabama Linebacker Defensive End

GUEST SPEAKER
MOTIVATIONAL MESSAGE
CHARACTER BUILDING

COME JOIN THE FUN!

Last Day to Sign Up is May 2nd!

SIGN UP AT THE HEFLIN RECREATION CENTER or
Send Name, Address, Phone #, Email, Age, Grade, School Name, Position, Parent/Guardian Name & T-shirt Size to [e-mail]

Send payments Check or Money Order (Made out to Todd Bates Football Skills Camp) to
P.O. Box 1132 Heflin, AL 36264

SIGN-UP SHEET (PRINT COPY and PRINT INFORMATION):

Name: ______________________________________________________ Address: ________________________________________________________ ________________________________________________________ Home Phone: ( ) _______________________________________ Cell Phone: ( ) __________________________________________ E-mail: _________________________________________________ Age: ___________ Grade: ____________
Name of School: ________________________________________________________ Parent/Guardian Name: ________________________________________________________ Position: _______________________________________________

Circle T-Shirt Size YOUTH: S | M | L ADULT: S | M | L | X-L | 2X | 3X

Camp Cost: $40 FOR A COPY OF THE GROUP PHOTO ADD $5.00 check here if you would like a copy of the group photo

Method of Payment: Please Circle Check or Money Order Amount Enclosed:

Send Payment to: P.O. Box 1132 Heflin, AL 36264 Make Check/Money Order payable to: Todd Bates Football Skills Camp

Sponsored by Heflin Parks & Recreation Department 1228 Coleman St. Heflin, AL 36264 [phone]

Please include sign-up sheet and signed Medical Release Form with payment.

Waiver & Release of Liability Agreement
This form must be read and signed unaltered before the participant is permitted to take part in the Todd Bates Football Skills Camp. By signing this agreement, the participant affirms having read and understood it and is in agreement with its contents. IN CONSIDERATIONS of my involvement in the activities under the Heflin Parks and Recreation Department I, _____________________________________ (participant’s name), acknowledge, appreciate and agree that:

I hereby give my permission for a qualified physician, athletic trainer and/or hospital emergency room to administer necessary healthcare in the case of an accident and/or emergency. I hereby hold the Heflin Parks and Recreation Department and the Todd Bates Football Skills Camp harmless for any/all injuries or damages for the above child’s participation in the camp activities. I understand that photographs may be taken of me during the Todd Bates Football Skills Camp. I do for myself, my heirs, executors and administrators, remise, release, waive and forever discharge the Heflin Parks and Recreation Department and the Todd Bates Football Skills Camp and all of its officers, agents and employees, acting officially or otherwise, from all claims demands, actions, or causes of action, on account of any injury, death or property damage which may occur at any time or for any cause during participation in the Todd Bates Football Skills Camp.

FOR PARTICIPANTS OF MINORITY AGE:
This is to certify that I/we are parent(s)/guardian(s) with legal responsibility for this participant, do consent and agree not only to his/her release, but also for myself/ourselves, and my/our heirs, assignees and next of kin to release and indemnify the Heflin Parks and Recreation Department and the Todd Bates Football Skills Camp from any and all liability incident to my/our minor child’s involvement as stated above.

I have read this Release of Liability and Waiver Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

Participant’s Signature: ______________________________
Print Name: __________________________ Date: / /2008

(ALL MINORS MUST HAVE PARENT’S SIGNATURE)
Parent/Guardian Signature__________________________________________
Print Name: _______________________________________
Date: __ /__ /2008

“Molding today’s youth into tomorrow’s Superstars…on and off the field!”