Rio Grande Football Camp

Thank you for your interest in our University of Rio Grande Football program. We are excited to have you a part of our camp.

Camp Info

$50 - Cash or Check

Contact Head Coach Quincy Wilson (740)245-7769

qwilson@rio.edu

X: @coach_qwilson

July 14th, 2024

Jackson High School

500 Vaughn st

Jackson, OH 45640

10 am - 2 pm

$50 - Cash or Check

Email address *

First name *

Last name *

Address 1 *

City *

State *

ZIP Code *

Cell Phone Number *

Twitter Account/X *

Age *

High School Class *

Name of High School *

Name and Contact of High School Coach *

Name and Cell Phone

Position *

Assumption of Risk/Medical Consent

I wish to participate in the University of Rio Grande’s Football Camp— July 14th.
The URG Football Program or anyone connected with the University of Rio Grande will not be responsible for accidents or injuries that occur due to participation, nor will they be responsible for medical, dental, or any other expense incurred due to an accident or injury. I hereby assume voluntarily any risk of accident or injury to myself due to participation. I also grant the right to administer all medical services that may be necessary due to participation, including emergency or referral services.

Have you ever been told you have a heart condition? *

Yes / No, (If yes, please explain.)

Have you ever had a head injury / concussion? *

Yes / No, (If yes, please explain.)

Have you ever had a heat related injury/illness? *

Yes / No, (If yes, please explain.)

Are you currently taking any medications? *

Yes / No (If yes, please explain.)

Are you allergic to any medications? *

Yes / No (If yes, please explain.)

Do you have any Allergies? *

Yes / No, (If yes, please explain.)

Do you have Asthma *

Yes No

Do you have any medical conditions we need to be aware of? *

Yes / No (If yes, please explain.)

Emergency Authorization Information: Parent / Guardian *

Full Name / Cell phone number

Secondary Emergency Contact *

Full name / Cell phone number / Relation to showcase participant.

I hereby authorize the directors of the URG Football Camp to act for me according to their best interest in case of emergency requiring medical assistance and they will not be responsible for medical, dental or any other expenses incurred as a results of an accident. *

Participants Signature / Date

I hereby authorize the directors of the URG Football Camp to act for my athlete according to their best interest in case of emergency requiring medical assistance and they will not be responsible for medical, dental or any other expenses incurred as a results of an accident. *

Guardians Signature / Date

* required field