Junior WAKTEK Collision Safe Application Form

Parents Name

First NameLast Name

Childs Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Childs age

What code do they play?

What position do they play?

What reasons do you believe your child needs this program?

On a scale of 1 - 10 how would you rate your child's tackle technique

1 being poor, 10 being great

From the above selected, as a parent, what is your main priority for your child?

Is there anything else you’d like us to know about your child’s experience, confidence, or development in contact situations?

Before any 1 on 1 or group Collision Intelligence coaching sessions can take place. Your child must either: (1) Complete a minimum of 4 weeks of our Junior Collision Ready Strength Program and then a parent must complete and sign the Parent Peace of Mind Checklist. or (2) If you think your child is ready, complete and sign the Parent Peace of Mind Checklist. The link to download the app for the program and/or the checklist is here.

https://www.trainerize.me/profile/pinpointathlete3/?planGUID=788db4b38143454fa4352a82c050a98b