Dribble University New Client Registration Form

Dribble University Registration Form

Basic Information
Student Athlete Name*

First NameLast Name
Athlete's Age
Athlete's Skill Level

BeginnerBeginnger/IntermediateIntermediateAdvanced
How many days a week would you be interested in training?

Once a week1 - 3x a week3 - 5x a weekDaily
Additional Information
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Parent Phone Number*

Area CodePhone Number
Athlete's Phone Number

Area CodePhone Number
E-mail
How did you hear about us?*
Other*
Emergency Contact Info

In case of emergency who should we contact? If the same as contact info leave blank.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Does your athlete have any allergies, chronic illness, or medical conditions that would limit high level activity?

YesNo
If yes, give a short description of the condition.
Parental Permission For Emergency Contact

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I give consent for the facility to secure any and all necessary emergency medical care for my child.
I Give Consent

YesNo
Release of Liability

Although the safety of all sport activities is the primary concern, indoor/outdoor sport training with Dribble University may cause injury and/or death. I expressly assume any risk and agree to waive the right to pursue any claim against Dribble University or any facility thats being used to work in
I Assume All The Risk

YesNo
I have read and agree to all above conditions

YesNo
Confirmation Email
example@example.com
Should be Empty:

Dribble University Registration Form

Emergency Contact Info

Parental Permission For Emergency Contact

Release of Liability