Athlete Academy Registration Form

Name of Parent:*

First NameLast Name

Name of Participant*

First NameLast Name

Phone Number*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How many youth are you registering?*

Youths name/s*

What grade/grades are the kids in?*

Are you a BCC Member?*

YesNo

Athlete Academy

Every Tuesday & Wednesday starting in June & will go until Augest 10th.

Grades 6th-8th will start at 10:30.

Grades 9th-12th will start at 12pm

Where: Becker Community Center

Memebers: Free

Non-members $8

Educating athletes to develop their skills in conditioning, preventing injury, and recovering. Maintaining movement throughout summer for overall athleticism and injury prevention. Focusing on: Strength, Speed, Agility, Stretching, and Plyometrics Training.

Permission granted for participant to be included in pictures and publicity connected with the BCC with no compensation to me. All pictures and video remain the property of the BCC.

I agree to release the Becker Community Center, City of Becker, their employees and leaders, of all liability related to accidents or injuries which myself or member of my family might incur while participating in this activity. If necessary, I authorize the Becker Community Center to administer first aid and/or authorize medical treatment if this becomes necessary. Participants are not covered under the Becker Community Center's or the City of Becker's medical insurance policy.

Signature*

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