Acceleration Sports Performance Athlete Information Form
Athlete Name
*
First Name
Last Name
Guardian Name
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Emergency Phone Number
Please enter a valid phone number.
Birth Date
*
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Month
-
Day
Year
Date
Sport(s): Please list all
*
EX. Soccer, Basketball
How did you hear about us (please include names so we can thank them!)
*
Please provide us with any and all relevant medical information (including injuries, known diseases/disorders)
*
Please provide details if any
*
Are you currently taking any medications? If yes, please list
*
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RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY ANDINDEMNIFICATION AGREEMENT:ACKNOWLEDGEMENT OF RISK AND DANGER AND ASSUMPTION OF RISK
I am fully aware of the inherent and unforeseen risks associated with utilizing the facilities and equipment provided by the Acceleration Sports Performance Program, which may result in injuries or even death. I accept full responsibility for any such risks, encompassing injuries sustained due to facility defects, the negligence of others, and even my own misuse or negligence. In consideration of my access to these facilities, services, and equipment, I hereby release Acceleration Sports Performance Program, its successors, officers, directors, agents, and employees from any and all claims or liabilities of any nature, vowing not to initiate any legal action against them. Furthermore, I pledge to indemnify and hold harmless the program, its successors, officers, directors, agents, and employees from any claims, demands, liabilities, or judgments stemming from my own or my child/ward's use of their facilities and equipment.
*
Initials - If minor, parent/guardian/conservator
PERMISSION TO PROVIDE MEDICAL TREATMENT AGREEMENT
I HEREBY give my permission for my son/daughter to undergo medical treatment for any injury or illness he/she may sustain or acquire while engaged in the Acceleration Program. I understand that the personnel of the Acceleration Sports Performance Program use only those procedures, which are within their training, credentialing and scope of professional practice to prevent, care for and rehabilitate injuries. In the event that more serious medical procedures are required, such as surgery or other invasive procedures, I understand that attempts will be made to contact me for my consent. I understand that if my child suffers a potentially life threatening injury or illness, and in the event I am unable to be contacted within a reasonable period of time, that I authorize any duly licensed medical practitioner to perform such procedures as may be medically necessary to alleviate the problem
*
Initial - If minor, parent/guardian/conservator
Training Fees/Refunds
Acceleration Sports Performance Programs are non-transferable other than to immediate family. Depending on the package or monthly contract purchase, training will have an end date that starts at the point of enrollment: 1-12 sessions: 6 Months, 55 sessions: 24 months, 25 sessions: 12 Months, 75 sessions: 36 Months, 35 sessions: 18 Months
If after this time, training has not been completed, the remainder of your account will be forfeited. Cash refunds will not be given.
*
Initial - If minor, parent/guardian/conservator
Media
Acceleration Sports Performance tracks and publishes its outstanding results via print and video outlets. I grant Acceleration Sports Performance the right to track my training progress through photography, video, and published documents. Acceleration will not publish any form of performance that does not represent Acceleration Sports Performance or the athlete to the highest standards.
*
Initial - If minor, parent/guardian/conservator.
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Scheduled Appointments
Any individual failing to show for a scheduled Acceleration Sports Performance Program session will forfeit a paid session. Under a monthly contract, that athlete’s contract will be fined $20.Cancellations are to be made 24 hours in advance. Athletes canceling on the day of their appointment will be charged for that session. Cancellations made over 24 hours in advance of the scheduled training session will result in a full refund of the session with no cancellation penalty. Cancellations will be granted under special circumstances including but not limited to sickness, family emergency, and injury. Any athlete that is 5 to 15 minutes late for a scheduled appointment will receive a modified training session to fit the remaining time of the session. If the individual is over 15 minutes late for an appointment, they will forfeit that session.
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Initial - If minor, parent/guardian/conservator.
By signing below, I hereby acknowledge that I have completely read and fully understand the Acceleration Sports Performance Policy Guidelines. (If minor, Parent guardian/conservator signature.)
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Date:
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Month
-
Day
Year
Printed Name:
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