Atomic Sports Physio and Performance
Name of Event: The Atomic Athlete Experience Cross-Train Camp
Tuesdays 8:30 am - 10:00am
Thursdays 8:30 am - 10:00am
Fridays 8:30 am - 10:00am
Tuesdays 5:00 pm - 6:30pm
Thursdays 5:00 pm - 6:30pm
Participation Date Notes:
Date of Birth
Emergency Contact Name:
Medical History/Food Allergies:
Current Athletic Team or Activity Participation:
Physical Condition/Medical Authorization:
I hereby certify that my child is physically fit to participate in the Event and to participate in all activities conducted in conjunction therewith the Event, and I have not been advised otherwise. I agree that before my child participates in any activity conducted in conjunction with the Event, I or my child will inspect the related facilities and equipment. In connection with any injury sustained or illness or medical conditions experienced during my child's attendance in connection with the Event, I authorize any emergency first aid, medication, medical treatment or surgery deemed necessary by the attending medical personnel if I am not able to act on my child's behalf. Additionally, I authorize medical treatment for my child, at my cost, if the need arises; however, I acknowledge that the Released Parties shall have no duty, obligation or liability arising out of the provision of, or the failure to provide medical treatment. The "Released Parties" include Atomic Sports Physio and Performance, LLC and RHC Association, Inc., d/b/a River Hills Country Club.
EQUIPMENT AND FACILITIES INSPECTION:
I, or my child if I am not in attendance at the Event/Activity, will immediately advise the Event manager of any unsafe condition that I, or my child or observe. My child will refuse to participate, and I will refuse to let my child participate, in the Event until all safe conditions observed by me, or my child, have been remedied.
Photographs and video will be taken during camp to utilize as marketing material. By signing below I consent to the use of these photographs of my child be used in a professional manner.
Parent of Guardian Signature
Parent or Guardian Print:
( X )
Atomic Athlete 21 Sessions
Atomic Athlete 14 Sessions
Atomic Athlete 7 Sessions
Atomic Athlete Single Session
Each camper will get personal equipment to use during camp and following to continue getting stronger at home. Package includes a mobility ball, 2 resistance bands and a jump rope.
Credit Card Number
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