Higher Intentions: Back To School (1-Day Clinic)

Higher Intentions

August 17th: Back To School (1-Day Clinic)
Athletes Information

Personal & Medical
Name:*

First NameLast Name
Sibling Name (if applicable)

First NameLast Name
Birthdate:*

MonthDayYear
Sibling Birthdate (if applicable):

MonthDayYear
Grade (Entering This Fall):*
Sibling Grade (Entering This Fall):
T-Shirt Size:*

Youth SmallAdult MediumYouth MediumAdult LargeYouth LargeAdult X-LargeAdult Small
Sibling T-Shirt Size:

Youth SmallAdult MediumYouth MediumAdult LargeYouth LargeAdult X-LargeAdult Small
Athletes Phone Number (If Applicable):

Area CodePhone Number
List Any Allergies and Dietary Restrictions:
Medications & Frequency (if needing to take any during camp hours:
Any Other Medical Information:
Parent / Guardian Information

(All correspondence and invoices will be sent to this person)
Name:*

First NameLast Name
Email:*
example@example.com
Cell Phone:*

Area CodePhone Number
Work Phone:

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Athlete:*
Parent 2/ Guardian 2 Information (Optional)

(All correspondence and invoices will be sent to this person)
Name:

First NameLast Name
Email:
example@example.com
Cell Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Athlete:
Emergency Contacts and Authorized Pick Up Persons: (At Least One)*
Payment

Check all that apply. Following your registration, please Venmo @HigherIntentions. For 1 Athlete - Total Payment Due: $150. To add a sibling - Total Payment Due: $250
Back To School (1-Day Clinic): $150Add a Sibling ($50 Off): $100
Terms & Conditions
I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY AND UNDERSTAND ITS TERMS. I SIGN IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS LEGAL SIGNIFICANCE.
Date:*

MonthDayYear
Signature:*

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Higher Intentions

Athletes Information

Parent / Guardian Information

Parent 2/ Guardian 2 Information (Optional)

Payment

Terms & Conditions