Football Registration & Intake Form 🏈🔥

Football Registration & Intake Form 🏈🔥

Complete this form to register for the Football Technical Institute and specify your training preferences.
Registration Type
Who is completing this registration?
If Other, Please describe your relationship to the athlete.
Athlete Information
Athlete First Name
Athlete Last Name
Date of Birth

MonthDayYear
Date
Age
Grade Level
Gender

Other
School Name
City
State
Athlete Cell Phone (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Athlete Email (if applicable)
example@example.com
Parent / Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Relationship to Athlete
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Street Address
City
State
Zip Code
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Football Experience
Years Played
Current Team
Current Coach Name

First NameLast Name
Current Coach Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participated in Football Camps Before
Athlete Measurements
Height (inches)
Weight (pounds)
40-Yard Dash Time

Hour Minutes

AM/PM Option
Bench Press (reps)
Squat (reps)
Medical & Health Information
Do you have any medical conditions?
Medical condition details
Do you have any allergies?
Allergy details
Current medications
Do you have asthma?
Have you had a concussion within the last 12 months?
Concussion details
Do you have any injuries that may affect participation?
Injury details
Physician name

First NameMiddle NameLast Name
Physician phone number
Please enter a valid phone number.Format: (000) 000-0000.
Health insurance provider
Policy number
Training Goals
Training goals
What specific skills should Coach Derek Martin help improve?
Camp Location Selection
Training Location
Training Days
Liability Waiver Text

I understand that participation in football training, conditioning, athletic drills, speed development, and related activities involves inherent risks including but not limited to falls, collisions, physical contact, sprains, fractures, concussions, illness, disability, or other injuries.

I voluntarily allow the athlete to participate in Football Technical Institute activities and acknowledge these risks.

I certify that the athlete is physically able to participate and has no condition that would prevent safe participation unless disclosed on this form.

I release and hold harmless Football Technical Institute (FTI), Coach Derrick Martin, instructors, staff, volunteers, facility owners, and affiliates from liability for injuries, damages, losses, or claims arising from participation except where prohibited by law.
I have read and agree to the Liability Waiver.
I agree to the Athlete Code of Conduct.
Electronic Signature
Printed Name
Date

MonthDayYear
Date
Parent/Guardian Signature
Should be Empty:

Football Registration & Intake Form 🏈🔥

Registration Type

Athlete Information

Parent / Guardian Information

Football Experience

Athlete Measurements

Medical & Health Information

Training Goals

Camp Location Selection