SPORTS PERFORMANCE TRAINING FORM

Sports Performance Training Form
Participant Name:*

First NameLast Name
Date of Birth:*
MM/DD/YYYY
Age:
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Emergency Contact:*

First NameLast Name
Relationship:*
Phone Number:*
Please enter a valid phone number.
Medical and Health History
Do you have any known allergies?*

YesNo
If yes, please list:*
If no, write N/A
Do you have any medical conditions (e.g., asthma, diabetes, heart conditions)?*

YesNo
If yes, please list:*
If no, write N/A
Have you had any recent injuries or surgeries?*

YesNo
If yes, please describe:*
If no, write N/A
Are you taking any medications?*

YesNoPrefer not to answer/medication does not impede physical activity
If yes, please list:*
If no, write N/A
Waiver and Release of Liability
I, the undersigned participant (or parent/guardian of a minor participant), acknowledge that participation in sports performance training involves inherent risks, including but not limited to physical injury, illness, or death.

I voluntarily assume all risks associated with participation and hereby release and hold harmless LOCKERROOM, its trainers, employees, agents, and affiliates from any claims, damages, or liabilities arising from participation, including transportation to/from sessions.
Signature of Participant:*

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Signature of Parent/Guardian (if under 18): *

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Date:*
MM/DD/YYYY
Media Waiver
I grant LOCKERROOM permission to capture and use photographs, videos, or recordings of me (or my child) for promotional purposes, including but not limited to social media, websites, and marketing materials. I understand I will not receive financial compensation for such use.
Do you agree to the Media Waiver?*

YesNo
Signature of Participant:

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Signature of Parent/Guardian (if under 18): *

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Date:*
MM/DD/YYYY
Parental Consent

(For Minors)
I, the undersigned parent/guardian, give permission for my child to participate in sports performance training with LOCKERROOM.

I have reviewed and agree to the terms outlined in this form, including the Medical and Health History, Waiver and Release of Liability, and Media Waiver.
Signature of Parent/Guardian:

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Printed Name of Parent/Guardian

First NameLast Name
Phone Number
Please enter a valid phone number.
Date:
MM/DD/YYYY
Appointment

Payment*

Training SessionExperience the pinnacle of personalized training with our exclusive 1-on-1 session. Benefit from tailored instruction, focused learning, and undivided individual attention. Book your appointment now to embark on a journey of skill enhancement and achievement.

$75.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Should be Empty:

Sports Performance Training Form

Medical and Health History

Waiver and Release of Liability

Media Waiver

Parental Consent

Payment Methods