Player Application | Kentucky Football Coaches Association- Forms

Player's Name*

First Last

Email*

Home Address*

Street Address City State ZIP Code

Cell Phone*

Home Phone*

Parent's Work Phone*

Height*

Weight*

T-Shirt Size*

Have you signed up to take the ACT?*

If you have signed up to take the ACT test on 12/10/2016 arrangements will be made for you to take the test in Louisville at:

Beth Haven School: school code #240720
Southern HS: school code #176540
Atherton HS: school code #242660

Yes
No

Will yo be driving to the hotel site?*

Yes
No

Head Coach Information

Please double check the accuracy of this information. It is very important that the information below, particularly the email address, is correct.

Name*

First Last

Email*

Cell Phone*

Principal Information

Please double check the accuracy of this information. It is very important that the information below, particularly the email address, is correct.

Name*

First Last

Principal Email*

Player Signature

Attestation*

I will travel with my teammates to all All-Star practices and functions in the transportation provided by the Kentucky HS Coaches Association. I agree to follow all of the rules set by the KHSCA, All-Star Coaches, and the practice site. Failure to comply with these rules could mean dismissal from the All-Star team. Any misbehavior at my high school or home (after I sign this form) that causes severe action by the authorities at school or by parents/guardians will be just cause to be dismissed from the team without recourse.

High School*

Date*

Player Signature*

Parent's Data

Parent/Guardian*

First Last

Email*

Parent Disclosure Statement*

My son has permission to attend/participate in the “Best of the Bluegrass” All Star Camp. I have no knowledge of any physical impairment that would affect or be affected by my son’s participation in the Kentucky All Star Camp. In the event of any emergency in which my son requires medical care, I authorize the staff of the Kentucky All Star camp to act for me to obtain for him whatever medical treatment the staff, in its best judgment, deems necessary and appropriate. I specifically consent to such treatment including, but not limited to hospitalization and surgery and will be responsible for any medical or other charges in connection with his attendance at the camp.

I acknowledge that at the Kentucky All Star Camp my son will participate in a sport that may involve, among other things, physical contact of the body with others person or objects, including the ground, that at the Kentucky All Star camp he may incur a risk of injury. I specifically waive and give up and release the Kentucky High School Coaches Association and the Kentucky All Star Camp, the Kentucky Football Coaches Association, its board members and staff along with the Louisville St. Xavier HS from liability for any claim for damages which I or my son may have for injuries or illness that may sustain at the Kentucky All Star Camp.

I authorize the Kentucky All Star Camp to use photographs or articles about my son for publicity purposes. In order for my son to participate in the Kentucky All Star Camp he has to have health insurance. The KHSCA will provide insurance for those in need.

Please provide your sons health insurance company and policy number on the form provided. Also sign the form with the needed phone numbers in which you are stating that you agree to this pages statements.

I have read the disclosure statement sent to me by the Game Director and I agree to abide with the disclosure statement.

Insurance Company*

Insurance Policy Number*

Mother's Work Phone

Father's Work Phone

Permission to Drive

Consent*

I give my son, listed above, permission to drive from his home to the LaQuinta Inn & Suites, 4125 Preston Hwy., Louisville, KY (502-368-0007) in Louisville, KY with arrival time at 2:00 pm. (est). He will give the game director, Jimmie Reed, his keys to his car when he arrives at the team camp site. The keys will be returned to my son on game day.

His car is not to be used during the all star camp for any reason without game director permission. He does have permission to follow the team bus to St. Xavier HS on game day

Parent/Guardian Signature

Parent/Guardian is signing off on the Parent's Data and Permission to Drive information.

Date*

Parent/Guardian Signature*

KFCA Application

Head Coach Information

Principal Information

Player Signature

Parent's Data

Permission to Drive

Parent/Guardian Signature