DL Coach & Special Teams Coordinator

Sam Cummings

Camp Coordinator

1 Day Indy

Camp

At

Midland University’s

Heedum Field

Monday July 25th

9 AM to 1 PM

Midland University

Football

Midland Warrior Football Staff

Head Football Coach

Jeff Jamrog 1st Year Midland University Head Football Coach

27 years of college coaching experience

13 years on staff at University of Nebraska

Nebraska Husker football player 1983– 1987

Mount Michael High School Graduate

Midland University Football Staff

Ryan Williams - Midland Off. Coord & QB’s Coach

Played QB at North Dakota State 1997-2000 (Capt.)

Jamison Bisch– Midland Def. Coord & LB’s Coach

Played DB at UW-River Falls 2003-2008 (Capt.)

Mike Caputo - Midland Offensive Line Coach

Played Center at Nebraska 2007-2011 (Capt.)

Jack Riggins - Midland Wide Receivers Coach

United State Naval SEAL Officer 1998-2016

PJ Smith - Midland Defensive Backs Coach

Played Safety at Nebraska 2008-2012

Tom Brinkman - Outside Linebackers

Josh Caraway - Defensive Line

Matt Purdom– Tight Ends

Registration Form *** Please register for the camp at our on line camp website registration at

http://www.midlandufootballcamps.com/ If you are unable to register on line use the paper format below

To be completed by parent or legal guardian. Please print clearly. Be sure to fill in all sections including signatures. Make sure to fill out one registration form per camper. Please return registration, waiver and payment to program address below.

Name_____________________________________________________________

Address__________________________________________________________

City_______________ St______ Zip__________________________________

Phone #__________________________________________________________

E-mail:___________________________________________________________

Camper, Date of Birth______________________________________________

Parents/Guardians Name__________________________________________

Ins. Company ____________________________________________________

Ins. Policy #_______________________________________________________

Emergency contact ________________________________________________

Emergency contact # ( )________________________________________

Individual Profile

Height___________ Weight____________ Age________________________

High School _______________________________________________________

Fall ’16 Grade _________________ T-Shirt Size________________________

Off Position_______________ Def Position____________________________

Primary Position ____________

Payment Information $35 Per Camper

*Make checks payable to Midland University Football*

THIS IS A PADDED CAMP

Please bring football cleats, helmet, shoulder pads, and mouthpiece

Midland University Football 900 N. Clarkson

Fremont, NE 68025

Office Phone: 402-941-5366

Fax Number: 402-721-9406

E-mail: williamsr@midlandu.edu

1 Day Indy Camp Waiver Information

Parental Consent, To Whom It May Concern: The undersigned does hereby give permission for our (my) child__________________________________ ______________________________________to attend and par-

ticipate in the Midland University Football Summer Camps at given locations during the summer months of June 1—July 31, 2016. We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to

the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medi-cal Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician

or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall

assume all transportation costs. The undersigned does also hereby give permission for our(my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Midland University. I

give permission for any pictures or videos taken during the confer-ence to be used at the discretion of Midland University, the students, faculty, staff, or other representatives. I release and forever dis-charge Midland University, their agents an servants, successors and assigns, directors, trustees, officers, employees, and other represent-

atives against loss from any and all present or future claims, de-mands or actions in law or in equity that may hereafter be made or brought by me or my child, by anyone on behalf of me or my child, or by anyone else on their own behalf for damages or any other legal or

equitable remedy on account of any injury, illness, physical condition, inconvenience, or loss sustained by my child during the planned activ-ities for which my child is registering to participate.

Parent/Guardian Name_________________________ Parent/Guardian Signature______________________ Date of Signature _________ Please list any medical conditions that may affect participation:

_____________________________________ Please list any medications the camper will bring

____________________________________ Can first aid such as ice packs and band aids be administered?:

____________________________________ Can over the counter medicines such as Tylenol, antacid or triple antibiotic be administered?:

_____________________________________ Please list any known allergies:

_____________________________________

Midland University 1 Day Individual Camp is a

great opportunity for all Nebraska and

surrounding area high school foot-

ball talent to put their skills on

display. The camp will be held on

the campus of Midland University

at the Warriors home stadium,

Heedum Field. This is an opportunity

to show off your talent in front of the

Midland University coaching staff. Mid-

land’s staff has a combined 60 years of

coaching experience at both the high school and col-

lege levels. While at camp, you will par-

ticipate in the same drills that the

Warriors use to prepare for game

day. These high intensity drills pro-

mote competition and will show

who wants to win! The area’s best

talent will be in Fremont to display

their talent. Don’t miss out on this great

opportunity to showcase your talent to

Warrior Football

Over 4 Hours on campus with Midland Football Program

Verified Testing for the recruiting process

- 40 yard dash

- Vertical Jump/Broad Jump

- Pro Agility

- L Drill

Verified Measurements

- Height

- Weight

Participate and learn high level football drills from the Mid-

land football staff

Opportunity to Compete against some of the areas top

competition in Nebraska

Complimentary Midland University Football T-Shirt

8:00am - 9:00 am Check-In 9:00am - 12:30 pm Testing Off/Def Practice Group Drills 12:30pm - 1:00pm Awards & Closing

Shoulder Pads

Helmet

Mouth Piece

Football Cleats

Camp Schedule for Monday July 25th

Included during the camp

Pads Needed for Camp