National Kicking Service 2009 Post Season Training, College Testing and Rating Camp Application Please fill in, then print the following form. Once printed, please sign the form below and make checks payable to:  National Kicking Service

Please mail the application with payment to:    Gene Muriaty    National Kicking Service    P.O. Box 135    Marshfield Hills, MA 02051 Camp Rates: 1st time NKS attendee Veteran NKS player/camper $ 395.00 $ 380.00 * Early enrollment is strongly recommended to secure a spot!   Name:      Street:      City:      State:     Zip:      Phone:      Age:      Graduation year:      Head Coach:      School Name:      School Street:      School City:      School State:      Zip:      Hometown Newspaper:        NKS veterans:  Please list the name, location and approximate date of previous NKS program attended.     Check one or more:  Soccer Style Kicker Punter Straight on Kicker Long Snapper     How did you hear about the National Kicking Service? Newspaper Your Coach Another NKS Camper Radio/TV NFL Player Internet Magazine NFL Coach     NKS POST SEASON TRAINING, COLLEGE TESTING AND RATING CAMP Stetson University - DeLand, Florida (30 miles from Orlando), January 17-18, 2009           Participant's Medical Plan:      Medical Insurance #:          My child has permission to attend the National Kicking Service kicking camp. I will notify NKS if my child is on medication or is restricted in any way from participating in all activities. In the event of any emergency in which my child requires medical care, I authorize the NKS staff to act for me and obtain whatever medical treatment the staff in its best judgement deems necessary and appropriate. I specifically consent to such treatment including but not limited to hospitalization and surgery and will be responsible for any medical or other charges in connection with attendance at camp. I acknowledge that at NKS kicking camps my child will participate in a sport that may involve among other things, physical contact with the body with other persons or objects, including the ground, that at the NKS kicking camps my child may incur a risk of injury. I specifically waive and give up and release National Kicking Service, its owners and staff, the owners, trustees and staff of the premises on which the NKS kicking camp is held from liability for any claim for damages which I or my child may have for injuries or illness that may be sustained at the NKS kicking camp. I authorize NKS to use any photographs or articles about my child for publicity purposes.       Parent/Legal Guardian  Signature:        Date: