NORTHEAST CLINICS
"The best individualized instruction in New England"

Home Up Football LLB Field Hockey Directions

QUARTERBACK AND RECEIVER CLINIC
APPLICATION

TEAM TUITION DISCOUNT:

For 10 or more attendees from the same school team there will be a $15 discount prior to the last day of the clinic.
Sibling discount $25.00 off each additional tuition.

NOTE:

Due to the increased enrollment demands all attendees who register after June 1, 2012 will have to pay a late registration fee of $10.


APPLICATION

 

 

Full Name of Attendee:
Street Address:
City:
State:
Zip:
Email Address:
Home Phone:
Emergency Phone:
School:
State:

MEDICAL POLICY

Please enroll my son. I understand that the school and clinic will not be liable or responsible for accidents and medical or dental expenses incurred as a result of participation in this program. In the event of injury or illness the clinic has my permission to seek any emergency medical treatment deemed necessary. I authorize the use of any photographs or articles about my son to be used by N.E. Football Clinic for publicity purposes.

I agree to the above statement

I do not agree to the above statement

Each participant must have their own medical insurance. NO ONE WILL BE PERMITTED TO ATTEND CLINIC WITHOUT THEIR INSURANCE COMPANY AND POLICY NUMBER LISTED ON THIS FORM. Please HIGHLIGHT the box, and type your information below:


Make checks payable to NORTHEAST CLINICS INC.
P.O. Box 839 - East Hampstead N.H. 03826

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