P.O.C. Youth Sports Performance Clinic Registration

Youth Elite Sports Performance Clinic Registration

Train Like a Professional Athlete!
Athlete's Name*

First NameLast Name
Dates

Apr 27th & Apr 28th

May 11th & May 12th

May 18th & May 19th

Time: 2:00-3:30pm (each day)

Ages: 14-18

Max Participants: 20 per day

Attire: Workout Gear & Sneakers (No Cleats)

What to Expect

Professional Coaching

Dynamic Flexibility

Strength & Conditioning Training

Speed & Agility Drills

Power & Explosiveness Movement
Training Location:

540 Pitts School Rd NW, Suite G, Concord, NC 28027
Athlete Information
Age*
Gender*

MaleFemale
Sport
ex. Football, Basketball, Baseball, Soccer
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alternative Phone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the athlete prescribed an inhaler? If yes, please explain any instructions.*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by this organization, during the selected camp. In exchange for the acceptance of said child’s candidacy by this organization. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless this organization. All its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against the organization. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.
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.
E-Signature*

Clear
CLINIC FEE*
prevnext( X )
Apr 27-28 Clinic2:00-3:30pm
$60.00



May 11-12 Clinic2:00-3:30pm
$60.00



May 18-19 Clinic2:00-3:30pm
$60.00 Quantity



Total

$0.00
Should be Empty:

Youth Elite Sports Performance Clinic Registration

Training Location:

Athlete Information

Parent/Guardian Information

Emergency Information