Athlete Registration Form
Please complete accurately and affix your e-signature upon completion.
ATHLETE Name
*
First Name
Last Name
Suffix
Date of Birth
*
/
Month
/
Day
Year
Date Picker Icon
Gender
*
Male
Female
N/A
PRIMARY SPORT PARTICIPATION
*
Please Select
Archery
Baseball
Basketball
Cheerleading
Crew
Cross Country
Diving
Fencing
Field Hockey
Flag Football
Football (American)
Golf
Gymnastics
Ice Hockey
Lacrosse
Rugby
Soccer
Softball
Swimming
Tennis
Track and Field
Volleyball
Wrestling
SECONDARY SPORT PARTICIPATION
Please Select
Archery
Baseball
Basketball
Cheerleading
Crew
Cross Country
Diving
Fencing
Field Hockey
Flag Football
Football (American)
Golf
Gymnastics
Ice Hockey
Lacrosse
Rugby
Soccer
Softball
Swimming
Tennis
Track and Field
Volleyball
Wrestling
Athlete plays for a:
*
School Team
Recreation Team
Travel Team
None
AREA of ATHLETIC DEVELOPMENT DESIRED:
*
SPEED
AGILITY
FLEXIBILITY
ENDURANCE
STRENGTH
MOBILITY
BALANCE
MENTAL ACUITY
POSTURE
JUMPING ABILITY
INJURY PREVENTION
INJURY RISK REDUCTION
PARENT/GUARDIAN INFORMATION
PARENT/Guardian Name
*
First Name
Last Name
Suffix
Home Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Relationship to Athlete
Please Select
Father
Mother
Adult Sibling
Grandparent/Relative
Guardian/Ward
Cell Phone Number
*
Parent/Guardian Contact Number
Email
*
Parent/Guardian Email Address
In Case of Emergency, please notify me first, then:
*
First Name
Last Name
Phone Number
*
Relationship to Athlete
Please Select
Father
Mother
Adult Sibling
Grandparent/Relative
Guardian/Ward
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MEDICAL INSURANCE, HEALTH & CONSENT INFORMATION
Is your child athlete COVERED under a HEALTH/MEDICAL INSURANCE Plan?
*
Yes
No
If YES, enter name of MEDICAL INSURANCE Carrier:
Insurance Company Name
Group/Policy Number
Or upload copy of insurance card:
Browse Files
Drag and drop files here
Choose a file
Please upload front and back of insurance card.
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PRIMARY CARE DOCTOR/PHYSICIAN
First Name
Last Name
PRIMARY CARE DOCTOR/PHYSICIAN Address
Street Address
Street Address Line 2
City
State
Zip Code
DOCTOR/PHYSICIAN Phone Number
DOCTOR/PHYSICIAN E-MAIL Address:
example@example.com
List any or all your Child's HEALTH/MEDICAL HISTORY:
*
List any physical and mental issues (Ex: allergies, asthma, diabetes, etc.). If None, Type "NONE."
List any or all your Child's History of INJURIES or HOSPITALIZATION(S):
*
If None, Type "NONE."
List any or all your Child's MEDICATIONS and DOSAGES taken on a continual basis
*
If None, Type "NONE."
List any or all your Child's Health Condition that REQUIRE(S) ATTENTION during any sports activity:
*
If None, Type "NONE."
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WAIVER AND RELEASE OF LIABILITY
*
FINANCIAL RESPONSIBILITY AGREEMENT
*
Signature
By signing above, I understand that (i) electronically signing and submitting any document(s) to 58 Sports legally binds me in the same manner as if I had signed in a non-electronic form, and (ii) the electronically stored copy of my signature, any written instruction or authorization and any other document(s) provided to me by 58 Sports, is considered to be the true, accurate and complete record, legally enforceable in any proceeding to the same extent as if such documents were originally generated and maintained in printed form. I agree not to contest the admissibility or enforceability of 58 Sports' electronically stored copy of this Athlete Registration and any other documents. By using the System to electronically sign and submit any document, I agree to the terms and conditions of this Consent.
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2024 Summer Sports Training Schedule
58 SPORTS LLC
St. Paul VI Catholic High School
42341 Braddock Rd, Chantilly, VA 20152
Weekly Training Schedule
June 17 - 21, 2023 (4 pm - 5:15 pm)
June 24 - 28, 2023 (4 pm - 5:15 pm)
July 1 - 5, 2023 (4 pm - 5:15 pm)
July 8 - 12, 2023 (4 pm - 5:15 pm)
July 15 - 19, 2023 (4 pm - 5:15 pm)
July 22 - 26, 2023 (4 pm - 5:15 pm)
July 29 - August 2 (4 pm to 5:15 pm)
PAYMENT/CHECKOUT
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2024 Summer Sports Training (Weekly Rate)
Paul VI Catholic High School - Chantilly, Virginia
$
175.00
Total No. of Weeks
1
2
3
4
5
6
7
Item subtotal:
$
0.00
2024 Summer Sports Training - (7 weeks)
Sign up for 7 weeks and save over 55%!
$
525.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
NOTE: 58 Sports will appear on your credit card transactions.
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