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TRANSCRIPT
Name: Phone: ________ Grade: Fall ‘1 ___ Age: _
Address: City, State, & Zip: _____________________
School : _________________________________ High School Head Coach: ________________________________
Off. Pos.: ____________ Def. Pos.: ____ _________ Spec. Teams: _________ ____ Height ________ Weight ________
Commuter Resident T-Shirt Size: S M L XL XXL Medical Condition: _____________________
I hereby authorize the staff of the Upper Iowa Team Football Camp to act for me according to their best judgement in any emergency requiring medical attention. I know of no preexisting injury,
condition or illness which would effect my child’s ability to participate. My son has a current physical that clears him for all physical activity. I further acknowledge that Tom Shea or anyone else
associated with the Upper Iowa Team Football Camp will not be liable for any damage from injury or illness sustained at the Upper Iowa Team Football Camp.
Primary Insurance Company & Policy # ___________________
Signature of Parent or Guardian: ________ _________ Amount Enclosed: $
Parent Work or Emergency Phone #: _____________ _______
PEACOCK FOOTBALL CAMP ENTRY FORM
FOR
MO
RE
INFO
RM
ATI
ON
, CO
NTA
CT:
Tom
Sh
ea
Hea
d C
oac
h
Cam
p C
oo
rdin
ato
r 5
63
-42
5-5
31
3sh
eat@
uiu.
edu
UP
PER
IO
WA
FO
OTB
ALL
TE
AM
CA
MP
JU
LY 2
, 2
01
201 UPPER IOWA FOOTBALL
201 SCHEDULE || 9/ at | 9/ | 9/1 at | 9/2 | at a State | 10/ | |
| 10/2 State | | 11/1 at State
July
2El
igib
le C
amp
ers
Stud
ents
Ent
erin
g 9
th-1
2th
Cam
p D
etai
ls
Ho
usin
g:
All
Cam
per
s w
ill s
tay
in r
esid
ence
hal
ls o
n ca
mp
us.
Lost
key
s w
ill in
cur
a $4
0.0
0 fe
e.
Mea
ls:
Mea
ls w
ill b
e p
rovi
ded
by
Ara
mar
k Fo
od
Ser
vice
Dis
cip
line:
Any
ser
ious
vio
latio
n o
f cam
p r
ules
will
re
sult
in im
med
iate
dis
mis
sal w
itho
ut r
efun
d.
Cam
p F
orm
at
1.
Ind
ivid
ual P
osi
tion
Dri
lls &
Fun
dam
enta
ls w
/Up
per
Iow
a C
oac
hing
Sta
ff (o
ffen
se &
def
ense
)
2.
Gro
up W
ork
(Ins
ide
Run
& S
kele
ton)
w/
HS
Co
ache
s
3.T
eam
Wo
rk (1
1 o
n 1
1 H
igh
and
Har
d) w
/ H
S C
oac
hes
Insu
ran
ce
Up
per
Iow
a Te
am F
oo
tbal
l Cam
p w
ill c
arry
a s
eco
ndar
y m
edic
al in
sura
nce
po
licy
that
will
wo
rk in
co
njun
ctio
n w
ith t
he p
aren
t’s p
rim
ary
po
licy.
Thi
s p
olic
y w
ill p
ay fo
r o
nly
spo
rt-r
elat
ed in
juri
es t
hat
occ
ur w
hile
att
end
ing
ca
mp
act
ivit
ies.
A C
ertif
ied
Ath
letic
Tra
iner
will
be
on
staf
f at
all t
imes
.
Wh
at to
Bri
ng
Bed
din
g/P
illo
ws
for
twin
bed
Toile
trie
s (s
ham
po
o, s
oap
, to
oth
pas
te, e
tc.)
Hel
met
, Sho
uld
er P
ads,
Jers
ey, H
ip P
ads,
Kne
ePa
ds,
Thi
gh
Pad
s, M
out
hpie
ce, B
elt
Foo
tbal
l Sho
es a
nd T
enni
s Sh
oes
Sho
rts,
So
cks,
Jock
, and
T-S
hirt
s
$17
0.0
0*
Pri
ce L
ist
Res
iden
t
Ret
urn
En
try
Form
to:
Up
per
Iow
a Te
am F
oo
tbal
l Cam
p
Up
per
Iow
a U
nive
rsity
PO
Bo
x 1
85
7
Faye
tte,
IA 5
21
42
Reg
istr
atio
n
Che
ck-I
n:
Tue
sday
, Jul
y 2
th ||
11
:30
-1:3
0 p
.m.
Stud
ent
Cen
ter
Co
mm
ons
Che
ck O
ut:
Thu
rsd
ay, J
uly
2th
|| 1
1:0
0 a
.m.
PEA
CO
CK
FO
OTB
ALL
. . .
C
ATC
H T
HE
EXC
ITEM
ENT!
!!
Past
Up
per
Iow
a Fo
otb
all
Cam
p P
arti
cip
ants
Des
Mo
ines
Ho
ove
r M
on
tezu
ma
Ham
pto
n D
um
on
t C
olu
mb
us,
Wat
erlo
o
Car
roll
W
ater
loo
Eas
t W
auk
on
W
est D
elaw
are
Do
wli
ng-
Des
Mo
ines
W
illi
amsb
urg
C
layt
on
Rid
ge
Po
cah
on
tas
Gre
en M
ou
nta
in G
arw
in
Ind
epen
den
ce
Fort
Do
dge
D
es M
oin
es R
oo
seve
lt
Wes
t Lib
erty
C
har
les
Cit
y P
ost
vill
e St
arm
on
t C
lear
Lak
e La
wto
n/B
ron
son
D
enve
r M
FL M
arM
ac
Pek
in-P
ack
wo
od
Ti
pto
n
No
rth
Ced
ar
Wes
t Bu
rlin
gto
n
Up
per
Iow
a Fo
otb
all T
eam
Cam
p T
enta
tive
Dai
ly S
ched
ule
Day
1
11
:30
-1:3
0
Che
ck-I
n 1
:30
C
oac
hes
Mee
ting
(And
res
Cen
ter)
2
:15
C
amp
Mee
ting
Caf
eter
ia
3:0
0
Stre
tch
Hal
f-R
ack
3:1
0Te
am P
rep
4:2
0Se
cure
Ca m
p5
:00
Din
ner
6:5
0
Stre
tch
Full
Pad
s 7
:00
Sk
elly
/ O
L vs
. DL
7:4
5
Bre
ak
7:5
0
Insi
de
Run
/ 1
on1
WR
v. D
B’s
8
:10
Switc
h St
atio
ns8
:15
In
sid
e R
un /
1o
n1 W
R v
. DB
’s
8:3
5
Secu
re C
amp
/ A
war
ds
9:0
0Sn
ack
Bar
9:3
0C
oac
hes
Soci
al1
0:3
0Li
ght
s O
ut
Day
2
6:5
0
Wak
e-up
/ H
igh
Scho
ol C
oac
hes
7:0
0B
reak
fas t
8:3
0
Stre
tch
/ Fu
ll Pa
ds
8:4
0
Ind
ivid
ual P
erio
d -
UIU
Co
ache
s 9
:05
Switc
h St
atio
ns9
:10
In
div
idua
l Per
iod
- U
IU C
oac
hes
9:3
5Sw
itch
Stat
ions
9:4
0
Insi
de
Run
/ 1
on
1’s
WR
v. D
B’s
9
:55
Switc
h St
atio
ns1
0:0
0
Insi
de
Run
/ 1
on1
WR
v. D
B’s
1
0:1
5Te
am P
rep
10
:35
Team
Scr
imm
age
11
:00
Switc
h St
atio
ns1
1:0
5Te
am S
crim
mag
e1
1:3
0
Team
Pre
p /
Aw
ard
s 1
2:0
0Lu
nch
1:4
5
Stre
tch
Full
Pad
s 1
:50
Team
Pre
p2
:30
B
reak
2
:35
Sk
elly
/ O
L v.
DL
2:5
5Sw
itch
Stat
ions
3:0
0
Skel
ly/
OL
v. D
L 3
:20
Team
Pre
p3
:30
Te
am S
crim
mag
e 3
:50
Sw
itch
Stat
ions
3
:55
Team
Scr
imm
age
4:1
5
Team
Pre
p /
Aw
ard
s 5
:00
Din
ner
6:5
0St
retc
h /F
ull P
ads
7:0
0
Insi
de
Run
/ 1
on1
’sW
R v
. DB
’s
7:1
5Sw
itch
Stat
ions
7:2
0
Insi
de
Run
/1
on1
’sW
R v
. DB
’s
7:3
5Te
am P
rep
7:4
0
Go
allin
e /
Kin
g o
f the
Hill
8
:40
Se
cure
Cam
p /
Aw
ard
s 9
:00
Sn
ack
Bar
Op
en
9:3
0C
oac
hes
Soci
al1
0:0
0Li
ght
s O
ut
Day
3
6:5
0
Wak
e-up
/ H
igh
Scho
ol C
oac
hes
7:0
0B
reak
fas t
8:3
0
Stre
tch
/ Fu
ll Pa
ds
8:4
0
Team
Pre
p
8:5
0
Insi
de
Run
/ 1
on1
WR
v. D
B
9:1
0Sw
itch
Stat
ions
9:1
5
Skel
ly /
OL
v. D
L 9
:35
Switc
h St
atio
ns9
:40
Te
am S
crim
mag
e 1
0:0
0
Team
Pre
p
10
:10
G
oal
line
/ K
ing
of t
he H
ill
10
:50
Secu
re C
amp
10
:55
Cam
p A
war
ds
11
:20
Che
ck-O
ut