2010 Mehlville Panthers Training Package Registration
In an effort to help you and your team improve this off-season EFA is offering the entire Mehlville Football Program a special limited time training package.
First Name:
Last Name:
Phone:
E-mail:
Address:
City:
State:
Zip:
Alt Phone:
Personal Information
Parental/Emergency Contact Information
Camp Waiver
I have read, understand, and abide by the following information. My child has my permission to participate in Elite Football Academy Activities. I certify that my child has been examined by a licensed physician within the last 12 months, and is able to participate in all football related physical activities. I understand that my child may come in contact with other people and objects, and I hereby waive all rights to future claims related to such contact or injuries sustained as a result of such contact. I agree to assume any and all risks associated with my son’s participation in Training Sessions and release Elite Football Academy, its Owner, Staff, Participating Facilities, Host Schools and their respective School Districts from any and all liability related to injury or illness my son may sustain during training. I authorize Elite Football Academy, in the event of a medical emergency to transport and/or seek the necessary medical treatment for my child.
Football Information
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Height (Inches):
Height (Feet):
Weight:
What are the skills you would like to work on:
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Position:
Father/Guardian Name:
Father/Guardian Phone Number:
Mother/Guardian Name:
Mother/Guardian Phone Number:
Emergency Contact Name:
Emergency Contact Phone Number:
Insurance Carrier:
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Once you click the Proceed button, you will be taken to the Camp Payment Page. Simply click "Add to Shopping Cart" and enter your payment information. You have the choice to pay with a Paypal account or to use a major credit card. Thank you and we look forward to working with you this summer!
Online Payment Instructions
If you would like to pay with cash or check please contact EFA @ 636-346-1371
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Name Date
Serving the Entire St. Louis Missouri Metro Area
Elite Football Academy LLC 17363 Edison Avenue Chesterfield, MO 63005 P:636.346.1371 F:314.787.9205
