Mental X Performance Health Clinic

All Covid Guidelines will be followed. Check in includes temperature checks, questionnaire and parent sign off. Each athlete must bring Mask & sneakers that will be worn entire time. Each athlete will sanitze hands and water bottles upon entering. Every 15 minutes there will be a water/sanitation break with wipes and hand sanitizer.

(If Sick within 48 hours of clinic please stay home)

**All Coaches are certified or licensed profressionals.

***by submitting this form below you agree that Good Counsel, LLC, Motivate the game and/or any of its affiliates can not be held liable for any injury or sickness. You agree that your picture and or video can be used by Motivate the Game for promotional purposes.
MENTAL X PERFORMANCE CLINIC

introduced to injury prevention and mental health strategies to enhance your game.
Registering Individual Athlete or Group? (Group is 5 or more)

Individual Group
Player Full Name or (Group Name if signing up 5 or more) *
Athlete Age (must be between 11-18) *
Parent/Coach Full Name *
School
Parent Contact Phone *
Parent Contact E-mail *
example@example.com
Player Cell Number (will be added to group chat)
City, Zip Code *
What Sport does your athlete play?
Number of players registering (must be 5 or more for group option, coach will be emailed individual waiver forms to be completed by player parent)
How did you hear about us?

Social Media Previous camp Sports team Referral Other
Which Session? 10 per session: (if sessions do not fill you may be notified and invited to another session time)

Session 1 at 2:00 pm Session 2 at 3:00 pm Session 3 at 4:00pm
Payment options

Pay Now for individual athlete or Group pay at clinic (online payment includes processing fee)

My Products

Mental x Performance Clinic March 21st The Rock, Indoor Gym 1601 S Colorado St. Salem, VA 24153 Motivatethegame@gmail.com ** Price includes processing fee (There are no refunds)

$ 43.99

Enter coupon

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

By submitting this form you agree that you will not particate in any fights, arguments or violent behaviors on the premises. you will maintain good sportsmanship at all times. You agree that no member of "motivate the game, Good Counsel, LLC or Zoned-in Performance" or any of its affiliats can be held liable in the event of any unlikely injuries, sickness, or related issues that may occur during training sessions. You understand that Motivate the Game is not intended to take the place of traditional therapy or counseling. Zoned in performance is not intended to replace traditional physical therapy if suggested by a doctor. You agree that in the event of a mental health or physcial health crisis you will contact the appropriate authorities. You understand that it is the athletes responsibility to sanitize before and after session. you agree to stay home if athlete is sick or running a fever. you understand that motivate the game will do everything to sanitize work out zones and avoid very close contact. You agree that session payment will be paid at the start of the session. Non refundable. Your pictures or videos of you may be used for promotional purposes.
Date

Month Day Year
Date
Parent/Coach Signature

Clear
Should be Empty:

MENTAL X PERFORMANCE CLINIC

Payment options