PG Student-Athlete Recruiting Service (PG ST.A.R.S)
Football Combine Registration and Release Form



Name: ____________________________ Grade: _______________

Parent's Name: ___________________________________________

Work #: ____________________ Home #: _____________________

Email address: ___________________________________________

School: ________________________ Coach: __________________

Position: Offense _____________ Defense ____________________


PARENTAL PERMISSION

Student must have parental permission to participate in this combine:

I, ___________________, give permission for my child, _______________, to participate 
in the Prince George's County Combine and waive any rights to hold Prince George's County 
Public Schools or the event sponsor, PG ST.A.R.S, liable for any injury or harm that may 
occur during this event. I also give permission for the PG ST.A.R.S to report the results 
of this combine to colleges and universities in any manner they deem appropriate, including
the internet.


Healthcare provider: ___________________ Policy #: ________________________

Doctor's Name: _________________________ Phone #: ______________________

Emergency Contact Information:

Name of Contact Person: ______________________ Relationship: _____________

Home phone #: ______________________ Other phone #: ____________________


______________________________      ______________
Parent/Guardian Signature                    Date

Mail form with payment to: PG STARS, P.O. Box 1952, Clinton, MD 20735.