PRIMe Performance & Physio Youth Strength

Youth Strength Class Registration

These classes focus on the fundamentals of footwork and speed dynamics as well as establishing a good foundation of movement and form for strength training. We also value the importance of today's youth learning their way around the gym in a respectful manner. 10 training sessions for $130, 6 sessions for $84 or $16 per session if paid individually. Credits expire 3 months after purchase and can be shared between family members. Contact madi@primetherapies.com with any questions.
Athlete Information
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade (Fall of 2024)
Class Days/Times (Can pick one class or multiple)
Payment Option (Class packs to be paid upfront. Can be shared between family members)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
Email
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is also granted to the PRIMe Performance & Physio staff and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Media Release

I authorize PRIMe Performance & Physio to use the above listed athlete in photographs and videos that may be displayed in their gym, their website and/or social media pages.
Cost & Payment Agreement
Cost will be $16/session, 6 sessions for $84, or 10 sessions for $130. All must be paid prior to class and/or when booking.

Payment will be accepted online via our online gym software with card or in person with cash or check to PRIMe Performance & Physio.

You must cancel 24 hours in advance for any booked classes or else you will be charged for the class or 1 credit will be used.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature
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Youth Strength Class Registration