Register for Gridiron Academy

After registering below you will be redirected to PayPal where you can pay the registration fee via credit card or PayPal account.

Please select your Gridiron Academy level. *

Discount rate of $500 is for FULL Payment only and open to the first 30 who chose this option. If you chose the PARTIAL payment the full fee is $750 with the next installment of $300 due on or by Feb 5th

Elite (grades 9-12): full payment - $500

Elite (grades 9-12): partial payment - $150

Elite Games Only): full payment - $195

Juniors (grades 2-6): full payment - $95

Linemen Academy (Rochester) Full Payment - $89

Select your Academy Location *

First Name: *

Last Name: *

Address *

City *

State *

Zip *

Home Phone: *

Cell Phone

Player's E-mail Address: *

Father's Name *

Fathers Email Address:

Mother's Name *

Mothers Email Address

School *

Grade *

Date of Birth *

Position Offense *

Position Defense *

Short Size *

Pants Size *

Shirt Size *

Insurance Carrier *

Policy Number

Physician's Name

Medical Conditions

Emergency Contact *

I/We give permission for any medical attention necessary to be administered to my/our child by a licensed Medical Professional in the event of an accident or injury until I/we can be contacted. This release is effective for the 2013 season. I /we will assume responsibility for payment of treatments.

I/We the parent of the above named child, give my approval for his/her participation in any and all activities of the RPA LLC. during the 2013 season.

I/We do further release, indemnify and hold harmless any liability, direct or indirect, from anyone representing the RPA LLC., and/or any of the members, officers, organizers, supervisors, any and all of them. In case of injury to my child, I hereby waive all claims against the organizers.

I am the parent/guardian above. I have read the waiver above and agree to all the terms & conditions.

Parent E-Signature *

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