Private Lesson Registration

Private Lessons Registration Form

After registration, we’ll text you to arrange your lesson. Once confirmed, you and your coach will receive a shared Google Calendar invitation.
Participant Information
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Full Name
Parent's Email Address
example@example.com
Parent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What city do you live in?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Full Name

First NameLast Name
Child's Full Name
Child's Date Of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Age At Start Of Program
Child's Skill Level
Pick A Sport
What areas would you like to improve on?
How Did You Hear About Us?

Participation & Consent
I am the participant’s parent or legal guardian and authorize participation in North County Sports Academy LLC (“NCSA”) programs. NCSA includes its owners, employees, independent contractors, agents, representatives, and volunteers. Activities include lessons, classes, camps, evaluations, organized activities, and use of training premises and equipment, including activities at other locations and associated travel.

Risks and responsibilities. Sports and physical activity involve risks, including being struck by balls, bats, or other equipment; collisions; falls; strenuous exertion; illness; property loss; and minor or serious injury, permanent disability, or death. These risks may arise from participants, other people, premises, equipment, or NCSA’s acts or omissions, including ordinary negligence. I understand these risks and voluntarily accept them to the extent permitted by California law. I will disclose relevant health concerns, follow safety instructions, report unsafe conditions, and obtain instruction before unfamiliar equipment is used. I understand that on-site medical services may not be available.

Release and indemnity. To the fullest extent permitted by California law, I release NCSA from claims arising from participation or use of premises or equipment, including injury, illness, death, and property loss caused by ordinary negligence. I agree not to sue on those released claims. I agree to indemnify and hold NCSA harmless from claims arising from participation, to the extent legally enforceable. This agreement does not release liability that cannot lawfully be released.

Understanding and governing law. I have read this agreement, understand that it gives up substantial rights, and sign voluntarily. California law governs. Any action must be brought in California, subject to applicable law. If a provision is unenforceable, the remaining provisions continue to the extent permitted by law.
Photo & Media Release:
If I select authorization below, I permit NCSA to photograph or record my child during programs and use the resulting media without compensation in public promotional, educational, or informational materials, including websites, social media, print, and advertising. I waive approval of the finished use. If I select no authorization, I do not permit promotional photography or recording of my child.
Photo and Media Permission
Parent/Guardian Full Name
Child's Full Name
Parent or Guardian's Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Medical Authorization and Emergency Consent Form
Participant Information
Child's Full Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Full Name
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Emergency Contact
Name:
Relationship to Participant:
Phone Number:
Format: (000) 000-0000.
Medical Information
Does your child have any allergies, medical conditions, injuries, or other health concerns that NCSA staff should be aware of?
Please Explain:
Is your child currently taking any medications?
Please Explain:
Emergency Medical Authorization
If my child becomes ill, is injured, or has a medical emergency during NCSA activities, I authorize staff to call emergency services, provide first aid within their training, and obtain emergency treatment if I cannot be reached. NCSA will make reasonable efforts to contact me promptly. I certify that the information provided is accurate and accept responsibility for my child’s medical expenses.
Parent/Guardian Full Name
Child's Full Name
Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Concussion Information and Acknowledgment Form
Purpose
This form confirms that parents/guardians and participants have received information regarding concussion risks and understand the procedures used by North County Sports Academy, LLC ("NCSA").
What is a Concussion?
A concussion is a brain injury caused by a bump, blow, or jolt to the head or body that can change how the brain functions. Symptoms may appear immediately or develop over time.
Common Symptoms Include:
- Headache
- Dizziness
- Confusion
- Nausea
- Blurred vision
- Sensitivity to light or noise
- Balance problems
- Memory difficulty
Important Safety Rule
If a concussion is suspected:
The participant will be immediately removed from activity and will not return the same day.
Return-to-Play Requirements
A participant may return only when:
- Symptoms have fully resolved
- Medical clearance is obtained if required
- NCSA return-to-play protocol is followed
Risks of Continuing Activity
Continuing to participate after a concussion can result in:
- Worsening brain injury
- Prolonged recovery
- Increased risk of serious complications
Acknowledgment
I acknowledge that:
- I have read and understand the concussion information above
- I understand the risks of concussion in sports activities
- I agree to follow NCSA concussion safety procedures
- I agree that my child will not return to activity the same day if a concussion is suspected
Parent/Guardian Full Name
Child's Full Name
Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Payment
Private Lesson Packages

Choose your private lesson package. Current sale pricing is shown below.

Private Lesson Packages

$52.49 Package

Enter coupon

Should be Empty:

Private Lessons Registration Form

Participant Information

Participation & Consent

Photo & Media Release:

Medical Authorization and Emergency Consent Form

Participant Information

Emergency Contact

Medical Information

Emergency Medical Authorization

Concussion Information and Acknowledgment Form

Purpose

What is a Concussion?

Common Symptoms Include:

Important Safety Rule

Return-to-Play Requirements

Risks of Continuing Activity

Acknowledgment

Payment

Private Lesson Packages

Choose your private lesson package. Current sale pricing is shown below.*

Choose your private lesson package. Current sale pricing is shown below.