2011 Mules Football Camp

Camp Housing Plan (Check One)

Day Camper - $140

Overnight Camper - $175

Full Name ______________________________ High School ______________________ Grade Next Fall __________

Address _________________________________________________________________ Phone __________________

City ______________________________ State _________ Zip______________ Height __________ Weight ________

2011

Mules Football Camp

Team Competition

June 10-12

2010

National Quarter Finals

11-3 Season (best in school history)

Camp Director - Chuck Clemens

660-543-8021

cclemens@ucmo.edu

Camp Positions (Circle One Offense & One Defense)

Offense - OL QB RB TE WR

Defense - DL DE LB DB

Camp Session

June 10-12

I hereby request that you accept the application for enrollment of _________________________ in the UCM Mules Contact Football Camp. In consideration of

your acceptance of the application, I hereby release the Board of Governors of the University of Central Missouri and all its employees from all claims on account of

injuries which may be sustained by my son while attending the UCM Mules Contact Football Camp; and I agree to indemnify the Board of Governors of the University

of Central Missouri and its employees for any claim which may hereafter be presented by my minor son of any such injuries.

I understand that any camper who does not abide by camp rules may be dismissed from camp with no refund. In the event of illness or injury, I hereby give my

consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment, and order injections, anesthesia or surgery. I will

be responsible for any medical and other charges in connection with my son's attendance at this camp.

I certify that my son is covered by the medical insurance policy listed below.

Medical Insurance Company ________________________________ Policy Number __________________________

Parent Signature ______________________________________ Emergency Contact Phone_____________________

Return to: Camp Director, UCM Mules Football Camp, 203 Multipurpose Building, Warrensburg, MO 64093

Make Checks Payable to: UCM Mules Football Camp

Take your team to the next

level at the

Areas of Emphasis

• Offensive and defensive team concepts
• Goal line, third down, and red zone team

situations

• Promotion of sportsmanship
• Proper blocking and tackling techniques
• Team building through competition

The UCM Mules

Football Camp is run

in accordance with all

MSHSAA and KSHSAA

rules and regulations.

UCM 1410-06

2011

UCM

Mules

Football

Camp