1. Pirate Football Campers will learn drills that teach the fundamentals of football. Coaches and former players will stress the importance of leadership skills. Camp will conclude with a Game Day atmosphere, lots of fun and awards for campers. Pads will not be needed. Camp will be Monday thru Wednesday. Instructors: Coach David Collins & Pine Tree Football Coaching Staff Grades:K – 5 Dates:June 8 - 10 (Mon. – Wed.) Location:Pirate Stadium Times:8:00 a.m. - 10:00 a.m. Fee: $40 What to Wear:Cleats, shorts, shirt, baseball cap and sunscreen. Pads will not be needed. ***There will be a $10 dollar late registration fee after May 22nd*** Register students based on grade level for the upcoming 2014-15 school year.

2. Please circle T-shirt size*: **Please Note if Short Size is Different** Child : Medium Large Adult: Small Medium Large X-Large XX-Large Camp NameDate(s) Time: AM, PM or Full Day Campus Fee Make checks payable to: PTISD AthleticsTotal 2015 Pirate Conditioning Course Check the athletics website http://classroom.ptisd.org/webs/athletics/home.htm for registration options or complete this form and deliver in person to the PTISD athletics office on the PTHS campus or by US mail to: PTISD Athletics, P.O. Box 5878 Longview, TX 75608.http://classroom.ptisd.org/webs/athletics/home.htm If registering on the day of the camp please have completed form and proper payment available upon arrival. Student Name: ____________________________________Grade 15 - 16: ________Campus: ______________________ Parent Name: __________________________________ Day Phone: ______________________ Parent Name: __________________________________Day Phone: _______________________ Phone:_________________________Email: ___________________________________________ Address: ______________________________________________ Zip: _____________________ Emergency Contact Name: __________________________Phone: ________________________ Parent Statements of Agreement & Guidelines Please initial indicating you have read, understand, and agree to the guidelines below: ______I understand that I may not leave my student at the camp unless there is a staff member present. ______I understand that my student will not be allowed to leave the camp with an unauthorized person or staff member. Only adults with valid photo ID, over the age of 18 can be authorized to pick up the student. ______I understand that I will be charged a $1.00 per minute late fee if I fail to pick up my student on time. ______I understand that my student may be removed from camp for any of the following reasons: 1. Failure to pay fees by designated deadlines. 2. Inappropriate behavior of a student that endangers themselves or others. 3. Failure to observe any of the conditions listed in the PTISD Student Code of Conduct. ______I release the Pine Tree Independent School District, its employees and agents from all claims and responsibility for physical injury and property loss. ______I understand that a full refund, less a $10 processing fee, will be issued when I cancel in writing five (5) business days before the camp begins. Fees will not be prorated for late enrollment, missed classes, or non-attendance. ______I give my consent for PTISD staff to photograph my student with the understanding that my student’s image could be used by PTISD for promotional materials, including the District’s web site, and may be shared with the local news media. Parent Signature: ______________________________________________ Date: ________________________ Non-Discrimination Statement: The Pine Tree Independent School District operates all educational programs without discrimination on the basis of race, color, religion, sex, national origin, age, disability or any other basis prohibited by law. The District complies with Title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Americans with Disabilities Act, and Section 504 of the Rehabilitation Act of 1973.