IE Clinic Sign-Up Form

Participant Name

First NameLast Name

Medications, Allergies or Medical Conditions?

Parent/Guardian

First NameLast Name

Email

example@example.com

Phone

area codephone number

Which clinic are you signing up for?

Shirt Size: Please add Toddler, Youth or Adult

Signature

By clicking 'Submit', I provide my consent via an electronic signature to enroll into Infinity Elite clinic(s). I understand that payment is due up front to reserve a spot and payments are non-refundable. Payment may be made by cash/check (in person or in the secure drop box) or via Venmo @ Infinity-Elite-MPC