Football Training Registration Form

iDareU Registration 2021

Locations: Atlanta, Roswell, Marietta, Columbus, Ga.

Atlanta Location: Call - 404.748.3730

Roswell Location: Call - 404.565.3385

Marietta Location: Call - 404.844.7311

Columbus Location: Call - 706.580.4717

Start Date: Jan. 11th

Location: Please call area number for address and time.

Athlete Information

New or Returner *

New iDareU Athlete Returning iDareU Athlete

Location: *

Atlanta Roswell Marietta Columbus

Head Shot *

Browse Files

Athlete Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Twitter Account *

Instagram Account *

Email *

example@example.com

Date of Birth *

Date

Height *

Feet & Inches

Weight *

Lbs.

Position *

QB RB WR OL TE DT DE LB DB

School *

Graduation Year *

Parent / Guardian Information

Parent / Guardian Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone *

Area Code Phone Number

Cell Phone *

Area Code Phone Number

E-mail *

Interested in Volunteering? *

Yes No

Emergency Contact & Health Insurance Information

Emergency Contact's Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Do you have health insurance ? *

Yes No

Insurance Carrier *

Name of Policy Holder *

Subscriber ID/Group Number *

Card Number / Card Date *

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy? *

Yes No

Please describe *

If No, put N/A in the box above.

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Release of Liability

Although the safety of all sport activities is the primary concern, outdoor sport activities at i-DareU facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against i-DareU and the persons in charge.

I have read and agree to the above conditions *

Yes No

Confirmation E-mail *

Signature *

Clear

Weekly payments will be setup to be paid through our ACH system.

Authorization

I hereby authorize Bill.com, on behalf of iDareU Academy Inc., to initiate entries to the bank accounts that I enter, or enable iDareU Academy Inc. to enter, on the Bill.com web site in order to pay amounts that I owe to iDareU Academy Inc. in accordance with instructions entered by iDareU Academy Inc. on the Bill.com web site and, if necessary, to initiate adjustments for any transactions credited or debited in error. I represent that I have authority to bind the organization that owns the bank accounts, and to authorize all transactions to the bank accounts that are initiated through Bill.com, I acknowledge that transactions initiated to the bank accounts must comply with the provisions of U.S. law. This authorization will remain in effect until the organization notifies Bill.com in writing to cancel it in such time as to afford Bill.com and the bank reasonable opportunity to act on it.

Name on Account *

Bank Name *

Bank Account Type *

Checking or Savings

Routing Number *

First set of numbers on check

Account Number *

Secound set of numbers on check

Payment Options *

Signature *

Clear

My Products *

Saturday Package $ 165.00

Lil' Monsters Package $ 175.00

Standard Package - Most Used $ 200.00

Platinum Package $ 200.00

Beast Mode Package $ 245.00

5th Quarter Package $ 100.00

NFL Combine Package - 8 weeks $ 2,000.00

NFL Combine Package - 10 weeks $ 2,500.00

Enter coupon

Total $ 0.00

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