YOUTH FOOTBALL CAMP FORM – NON-CONTACT – Youth NON CONTACT FORM Ty Nsekhe FREE Youth Football Camp – Non-Contact June 25, 2022 at James Bowie High School The Multi-Purpose Activity Center 2101 Highbank Dr., Arlington, TX 76018 Ages 6-18 *boys and girls welcome* Player Application Form COVID-19 NOTICE * I UNDERSTAND THAT DUE TO COVID RESTRICTIONS: NO SPECTATORS WILL BE ALLOWED Player/Child Name * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country USA Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Parent Phone * Parent Email * Player/Child Height * 2'0" 2'1" 2'2" 2'3" 2'4" 2'5" 2'6" 2'7" 2'8" 2'9" 2'10" 2'11" 3'0" 3'1" 3'2" 3'3" 3'4" 3'5" 3'6" 3'7" 3'8" 3'9" 3'10" 3'11" 4'0" 4'1" 4'2" 4'3" 4'4" 4'5" 4'6" 4'7" 4'8" 4'9" 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" 6'5" 6'6" 6'7" 6'8" 6'9" 6'10" 6'11" 7'0" 7'1" 7'2" 7'3" 7'4" 7'5" 7'6" 7'7" 7'8" 7'9" 7'10" 7'11" Player/Child Weight * 45 lbs 46 lbs 47 lbs 48 lbs 49 lbs 50 lbs 51 lbs 52 lbs 53 lbs 54 lbs 55 lbs 56 lbs 57 lbs 58 lbs 59 lbs 60 lbs 61 lbs 62 lbs 63 lbs 64 lbs 65 lbs 66 lbs 67 lbs 68 lbs 69 lbs 70 lbs 71 lbs 72 lbs 73 lbs 74 lbs 75 lbs 76 lbs 77 lbs 78 lbs 79 lbs 80 lbs 81 lbs 82 lbs 83 lbs 84 lbs 85 lbs 86 lbs 87 lbs 88 lbs 89 lbs 90 lbs 91 lbs 92 lbs 93 lbs 94 lbs 95 lbs 96 lbs 97 lbs 98 lbs 99 lbs 100 lbs 101 lbs 102 lbs 103 lbs 104 lbs 105 lbs 106 lbs 107 lbs 108 lbs 109 lbs 110 lbs 111 lbs 112 lbs 113 lbs 114 lbs 115 lbs 116 lbs 117 lbs 118 lbs 119 lbs 120 lbs 121 lbs 122 lbs 123 lbs 124 lbs 125 lbs 126 lbs 127 lbs 128 lbs 129 lbs 130 lbs 131 lbs 132 lbs 133 lbs 134 lbs 135 lbs 136 lbs 137 lbs 138 lbs 139 lbs 140 lbs 141 lbs 142 lbs 143 lbs 144 lbs 145 lbs 146 lbs 147 lbs 148 lbs 149 lbs 150 lbs 151 lbs 152 lbs 153 lbs 154 lbs 155 lbs 156 lbs 157 lbs 158 lbs 159 lbs 160 lbs 161 lbs 162 lbs 163 lbs 164 lbs 165 lbs 166 lbs 167 lbs 168 lbs 169 lbs 170 lbs 171 lbs 172 lbs 173 lbs 174 lbs 175 lbs 176 lbs 177 lbs 178 lbs 179 lbs 180 lbs 181 lbs 182 lbs 183 lbs 184 lbs 185 lbs 186 lbs 187 lbs 188 lbs 189 lbs 190 lbs 191 lbs 192 lbs 193 lbs 194 lbs 195 lbs 196 lbs 197 lbs 198 lbs 199 lbs 200 lbs 201 lbs 202 lbs 203 lbs 204 lbs 205 lbs 206 lbs 207 lbs 208 lbs 209 lbs 210 lbs 211 lbs 212 lbs 213 lbs 214 lbs 215 lbs 216 lbs 217 lbs 218 lbs 219 lbs 220 lbs 221 lbs 222 lbs 223 lbs 224 lbs 225 lbs 226 lbs 227 lbs 228 lbs 229 lbs 230 lbs 231 lbs 232 lbs 233 lbs 234 lbs 235 lbs 236 lbs 237 lbs 238 lbs 239 lbs 240 lbs 241 lbs 242 lbs 243 lbs 244 lbs 245 lbs 246 lbs 247 lbs 248 lbs 249 lbs 250 lbs 251 lbs 252 lbs 253 lbs 254 lbs 255+ Player/Child Food Allergies PLEASE LIST ALL FOOD ALLERGIES YOUR CHILD HAS Player/Child Age (As of 06/30/2022) * 6 7 8 9 10 11 12 13 14 15 16 17 18 Player/Child Age (As of 06/30/2022) Player/Child Grade (Fall 2022) * Kindergarten First Second Third Forth Fifth Sixth Seven Eight Freshman Sophomore Junior Senior College Player/Child Grade (Fall 2022) Player/Child School Name * Player/Child Team Name Player/Child Position * Never Played / None Offensive Line (OL) Center (C) Offensive guard (OG) Offensive tackle (OT) Quarterback (QB) Running Back (RB) Half/Full (HB/FB) Wide Receiver (WR) Tight end (TE) Defensive Line (DL) Defensive Tackle (DT); Defensive End (DE) Linebackers (LB) Middle Linebacker (MLB) Outside Linebacker (OLB) Defensive Back (DB) Cornerback (CB) Safety (S) Kicker (K) Punter (P) Holder (H) Long Snapper (LS) Kick/Punt Returner (KR,PR) Years Played Never Played 1 2 3 4 5 6 7 8 9 10 11 12 13 Player/Child Shirt Size * Youth - XS Youth - S Youth - M Youth - L Youth - XL Adult - XS Adult - S Adult - M Adult - L Adult - XL Adult - XXL CAMP REGISTRATION: 9:00-10:00am CAMP TIMES: 10:00 am. - 2:00 pm. CAMP FREE and lunch will be provided *Deadline to Register is June 16, 2022 This camp will take registration forms on a first come first serve basis. LIMITED SPOTS AVAILABLE Questions - Email: MaryAnnepB1M@gmail.com PARENTAL PERMISSION WAIVER: I hereby authorize the directors and staff of The Ty Nsekhe FREE Football Camp to act in my behalf using their best judgment in any emergency, including medical emergency. I hereby waive and release the Camp, its employees, directors, sponsors, suppliers and facilities from any and all liability for illness or injury incurred while my child is attending Camp. I know of no mental or physical problems that might adversely affect my child's ability to participate in this Camp. I hereby grant the Camp permission to use any photographs or video of my child for promotional purposes. Knowing, understanding, and fully appreciating all possible risk, I do hereby expressly, voluntarily, and willingly assume all risks and dangers associated with my child’s participation in this Camp. These risks could result in damage to property, personal and/or bodily injury or death. I CONSENT TO MY MINOR CHILD’S PARTICIPATION IN THIS CAMP. I HAVE CAREFULLY READ THIS AGREEMENT, FULLY UNDERSTAND ITS CONTENTS, AND HAVE SIGNED IT OF MY OWN FREE WILL. PARENT/GUARDIAN FULL NAME (this is your e-Signature) * By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Date * Parental Permission Waiver Form must be signed, dated and completed prior to DEADLINE June 16, 2022 *** Players will not be able to participate without a completed, signed & dated form*** COVID RESTRICTIONS: NO SPECTATORS ALLOWED Submit Don't Wait Any Longer. Get In Touch Today! Email Address Full Name Phone Number Message Send Message