West Lafayette Parks and Recreation
Spring Non-Contact Football Clinic For Grades K - 5
All prospective West Lafayette Football players are invited to sign up for this 4 day non-contact football clinic. We will work on basic football skills and fundamentals of the game as well as 7-on-7 games.
Coordinators: Shane Fry & Rick Roseman Location: Old Burtsfield School site
(1850 N. Salisbury St. -at the corner of Salisbury St. & Lindberg Rd.)
Days: Monday - Thursday Dates: April 7 - 10 (weather make-ups days will be the following week) Time: 4:00 - 5:30 pm Fee: $ 35 (complete form and submit payment to W.L. Parks & Rec. Dept.)
Participants should wear weather appropriate clothing, athletic shoes or molded rubber cleats, mouth guards and bring a water bottle.
Any special accommodations needs, Please notify our Department two weeks prior to the start of the program. 2014 Waiver/Registration form Grades K - 5 Football - # 105000-01 Name: _________________________________________ Phone #_______________________
Address: ________________________________________________ Birthdate:_____________ Grade: _______ Program Code # 105000-01
Parent/Guardian Email address: __________________________________________________
I understand that participation in activities sponsored by the West Lafayette Parks & Recreation Department (the Activities ) is available at my discretion, and that I am not compelled in any way to participate in any Activities. I understand that participation in Activities involves a degree of risk of injury and even death and that I am voluntarily participating in the Activities and using equipment and machinery with knowledge of the danger involved. In consideration of allowing my child to participate, I, for my child, myself and our heirs, representatives and assigns, herby release and forever discharge, and agree to indemnify and hold harmless, the City of West Lafayette, the West Lafayette School Corporation, the West Lafayette Parks and Recreation Department, and their Boards, officers, employees, and representatives and any person or entity acting on behalf, from any and all responsibility or liability (including attorney fees) for injuries, damages or death resulting from or arising out of my childs participation in any Activities or my childs use of equipment or machinery in connection with such Activities
____________________________________ Parent or Guardian Signature
__________________ Date
Make check payable to: City of West Lafayette Mail to: 1101 Kalberer Rd., W. Laf. IN 47906 OR use the Drop-in box located by our office entrance OR call us with your credit card at 775-5110 Office hours-Mon-Fri, 8 am - 4:30 pm Questions? Call us 775-5110