Sideline Screening Registration
Sign up your child easily and quickly
Parent's Full Name
*
First Name
Last Name
Parent's Email Address
*
example@example.com
Parent's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Is your athlete currently recovering from an injury?
Yes
No
Consent Agreement
*
I consent to a video analysis movement screening by a licensed physical therapist
I understand this is not a medical treatment or diagnosis
I understand that recordings may be used for promotional education or publicity purposes including website, social media and marketing without expected compensation and I can choose to opt of use, in writing, at any time.
I agree to receive the screening report
Additional Notes (optional)
This is a screen and not indicative of a medical diagnosis.
Submit Registration
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