Linebacker School Application & Medical Release

REQUIRED STEPS:  FILL OUT PLAYER(S) FORM and CLICK SUBMIT BUTTON.  CLICK MEDICAL RELEASE BUTTON AND PRINT AND MAIL MEDICAL RELEASE FORM

Please click on the SUBMIT button REQUIRED to send the form to Champion Coach Inc.

Registering more than one Player? Fill out the form for player 1 then click submit.  Repeat for each player.  Then proceed to pay by credit card.

Name:*

Address:*

City:.*

State:*

Zip Code:*

School:*

Grade:*

as of September 2012

E-Mail:*

Shirt size:*

DOB*

Phone #*

List weakness:

* means this is a required field

Please cllick the button left, print and mail the completed form.  We must have a medical release form.

There is a $45 cancellation fee.

EQUIPMENT NEEDED:  Helmet and cleats are required.  No helmet rental available.

Location: Harding Field Complex at Waltham High School, Waltham, MA

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