Page Title

Please check the session you are registering your child for.

USF Sports Field 12:00 to 2:00 Ages 14-18 Session Starts March 2,2008 thru April 6,2008

USF Sports Field 2:00 to 4:00 Ages 9-13 Session Starts March 2,2008 thru April 6,2008

Parents Information

First Name

Last Name

Phone Number

Email Address

Phone Number

First Name

Last Name

Email Address

Zip Code

Address

State

Please Read

Child Information

I am fully aware that, playing or practicing in sports involves risk of injury/illness.I understand that because of the nature of the sport physical exertion will occur during participation, and that injury during practice from physical exertion is possible. In return for the students being allowed to participate at PROtential Football LLC,I release and agree not to sue any of the players or employees of PROtential Football LLC, and their subcontractors, sponsors, agents, and affiliates from all present and future claims that my be made by the participate or me, my family, estate, heirs, or assigns for property damage,personal damage,personal injury, or wrongful death arising as a result of the participant's participation in clinics and caused by the ordinary negligence of the parties listed above, wherever, whenever, or however the same may occur I understand and agree that those listed are not responsible for any injury or property damage arising out of PROtential Football, even if caused by their ordinary negligence I understand that participation in sports involves certain risk, including, but not limited to serious injury. I am voluntary allowing participant to participate in the clinics with knowledge of the danger involved and agree to accept all risks of such participation. I certify that the participant is in excellent physical health, and may participate in strenuous and physical activities,including all training by PROtential Football LLC,. Permission is granted for participant to recieve emergency medical treatment, if needed.I also agree to indemnify and hold harmless those listed above for all claims arising out of participants participation at PROtential Football LLC,and all related activities.I agree to let the parties use participants name and likeness free of charge in any manor and for any purpose without compensation to me or participant. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state of  which the clinics are taking place and agree that if any portion of the agreement is invalid, the remainder will continue in full legal force and effect. I further agree thet any legal proceedings related to this waiver will take place in Tampa, Florida. I also understand that PROtential Football LLC, does not carry medical insurance of any kind. I am the participant or the parent or guardian of the participant.I am of legal age and am freely signing this agreement. I have read this form and understand that signing this form,I am giving up all legal rights and remedies.I represent that I am the student or the parent/guardian of the student listed above and I agree that tha terms of this release are binding on me and the student.

First Name

Last Name

Age

T-Shirt Size

Zip Code

Address

State

Main Position

Secondary Position

Emergency Contact Name

Emergency Contact Number

List any personal goal your son has here.

Second Child

First Name

Last Name

Age

T-Shirt Size

Important

Zip Code

Address

State

If you have read and understand the
terms and condition of PROtential
Football's Liability Wavier please verify
be clicking the box and initialing in
uppercase letters.

Check Box

Main Position

Secondary Position

Initials

Emergency Contact Name

List any personal goal your son has here.

Emergency Contact Number

Online Registration Form

After the completion of this form, you must mail a check in the amount
of the desired program. This should be paid in full by the registration
deadline. (Feb. 24,2008)
Make check payable to: PROtential Football
Mail to: 19046 Bruce B Downs Suite 83
Tampa,FL 33647

After the completion of this form, you must mail a check in the amount of desired program. This should be paid in full by the registration
deadline. (Feb. 24,2008)
Make check payable to: PROtential Football
Mail to: 19046 Bruce B Downs Suite #83 Tampa, FL 33647

Before (Feb. 24,2008)

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To pay by credit card call 1.813.401.1818