United Way of Meriden & Wallingford
Home  |  News & Events  |  Contact  |  Forms Page
United Way of Meriden and Wallingford
Join the Movement; Volunteer Today
Give Today
kids
Make a secure donation

Youth Clinic Registration

WHEN:   

Saturday, March 10, 2018, noon - 3 p.m.

WHERE:

Worthington Johnson Athletic Center, Choate Rosemary Hall - Christian Street, Wallingford, CT

FOR:

Ages 8 - 14

COST:

$50 per youth; Pre-registration mandatory

Registration for the NFL Youth Clinic includes both payment and the return of a completed Release and Hold Harmless Agreement. Please click the link below to access the agreement. (YOU MUST COMPLETE REGISTRATION PRIOR TO THIS EVENT IN ORDER TO COMPLETE REGISTRATION PROCESS!)

NFL Players' Weekend Registration Form

NFL Players' Weekend Credit Card Form


Please print, fill out and sign. Once completed, the agreement can be returned any of the 3 ways listed below.

Via fax : (203)235-4404

Via email ( Please scan in as PDF): thevolunteercenter@unitedwaymw.org

Via mail: United Way of Meriden and Wallingford 35 Pleasant Street, Suite 1E Meriden, CT 06450.

 

Pay with credit card below, or mail check/money order made payable to: United Way of Meriden and Wallingford, 35 Pleasant St., Suite 1E, Meriden CT 06450

 

Registrations will not be accepted without completed form and payment.  There must be a form filled out for each youth participants.  Spots are limited, so please have your registration in as soon as possible.  


Don't forget to like us on Facebook to see all of our updates and latest events! 

https://www.facebook.com/UnitedWayMW

(* Denotes Required Fields)

Contact Information

PARENT/GUARDIAN NAME *
PLAYER NAME *
AGE *
Shirt Size: Youth S/M/L/XL or Adult Small/Medium *
ADDRESS *
CITY/STATE *
ZIP *
EMAIL: *
HOME PHONE
PARENT CELL PHONE
Acknowledgement of Risk
I, (parent/guardian), hereby indemnify and hold harmless, United Way of Meriden and Wallingford, Inc., and its employees and partners from any liability arising from accident, injury, theft, or damages to the above-named participant in the football clinic held at the Worthington Johnson Athletic Center, Choate Rosemary Hall on March 11, 2017. The terms of this release form shall be construed as the entire agreement and may not be altered, amended, or modified except in writing and signed by both parties. The terms of this release shall be governed by the laws of the State of Connecticut. The parent or guardian must read and check the box below, indicting his/her acceptance.
I agree to the above - Acknowledgement of Risk *
I agree to the above acknowledgement
Grant of Permission
I/we, (parents/guardians) hereby grant permission and authority to United Way of Meriden and Wallingford, Inc., its officers and authorized employees and partners to act for us in executing verbal instructions or if unable to contact us, to act for us in dealing with physicians, available ambulance companies and hospitals, to obtain prompt medical attention for the participant named above in the event of any perceived medical emergency.
I hereby covenant and agree to release United Way of Meriden and Wallingford, Inc, its officers, agents and employees, and owners of any property concerned, and hold harmless from liability for any injury or damage which the above-named clinic participant may sustain while at the Worthington Johnson Athletic Center, Choate Rosemary Hall on March 11, 2017. I hereby consent that any photographs or video taken during the event may be used by the United Way of Meriden and Wallingford, Inc. and its participating member agencies for publicity purposes.
I agree to the above - Grant of Permission *
I agree to the above grant of permission
Pay with credit card below, ($50.00 per youth)

Credit Card Payment Information

(All credit card information must be filled out completely to make a payment.)
Card Type:
Card Number:
Name on Card:
Verification #:
Expiration Date: (MM/YYYY)

Enter the code shown above
More Info
*
Web Solutions Connecticut CT Website Design & Development Company