CKP Pass It Forward - Summer Leadership + Skills Series

Pass It Forward: Summer Leadership + Skills Series

Please fill out the registration information below. If you have any questions please email Chelsea Poppens at ckpathletics@gmail.com .
Athlete Information
Athlete Full Name

First NameLast Name
Grade
School District
Parent / Guardian Information
Parent Name

First NameLast Name
E-mail
example@example.com
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact Name

First NameLast Name
Relationship to Athlete
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the athlete have any allergies, chronic illness, or medical condition? If yes, please describe.
Waiver of Release & Liability

By checking this box and signing below, I acknowledge that participation in the CKP Athletics Clinics involves physical activity and inherent risks of injury. I voluntarily assume all risks on behalf of myself/my child.

I hereby release and hold harmless CKP Foundation, CKP Athletics LLC, Shoot360, its sponsors, coaches, volunteers, and staff from any liability for injury, illness, or damages arising from participation.

I also authorize emergency medical care if necessary and acknowledge that I/my child are responsible for any related expenses. I grant permission for photos/videos of me/my child to be used for promotional purposes.
Signature
Date

MonthDayYear
Date
Clinic Selection
Location: Horizon Events Center
Select the clinic:
I would like to apply for a scholarship (Limited availability)
Scholarship Application
Note: These questions help us ensure scholarships are awarded to families who need them most. Your responses are kept private and used only for scholarship selection. If selected, you’ll receive a confirmation email with next steps. Limited spots available.
Why would this scholarship be helpful for your family at this time?
Do you currently participate in free/reduced lunch at school?
Would your athlete be able to attend the clinic without scholarship support?
How many children or dependents are currently living in your household?
Please select your estimated annual household income (optional)
Anything else you’d like us to know?
Payments
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Registration Fee
June 12th, 19th, & 26th

$150.00

Total

$0.00

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Pass It Forward: Summer Leadership + Skills Series

Athlete Information

Parent / Guardian Information

Emergency Information

Clinic Selection

Scholarship Application

Payments

My Products*

Payment Methods

My Products