PLYOCITY INDIVIDUAL REGISTRATION

 

 

 PLAYER

 

 PARENT/ GUARDIAN

FIRST NAME:

 

FIRST NAME:

 

LAST NAME:

 

LAST NAME:

 

Date of Birth:

 

Relationship to player:

 
TEAM   COACH  

Height:

 

Home Phone:

 

Weight:

 

Cell Phone:

 

Gender:

 

Work Phone:

 

Sports Played:

 

 

Street Address

 

 

Health concerns: (if none, please state none)

 

City

 

TRAINING SESSION: (location and dates)

 

State, Zip

 

How did you learn about PlyoCity?

 

 

Email:

 

AMOUNT PAID:

 

$

NAME ON CREDIT CARD

 

CHECK NUMBER

 

CREDIT CARD NUMBER:

 

 

 

EXPIRATION:

 

 

 

 

 

 

PLYOCITY REGISTRATION WAIVER AND RELEASE

 

For good consideration, the undersigned does hereby waive, release, acquit and forever discharge PlyoCity directors, coaches and other club members, participants, volunteer parents, volunteer coaches, and any or all persons assisting with Plyometric Workout activities directly and indirectly associated with PlyoCity, and each of them from any and all known and unknown personal injuries and property damages which the player participant may suffer during the course of or as a result of Plyometric Workouts.

I, as a parent or legal guardian of ________________________________ (participant), also give my permission for this participant to receive minor medication when the need may arise. The trainer or other adult in charge may give this at the time. In case of emergency or in the case I cannot be reached, I authorize emergency treatment for my child at the nearest recognized medical facility.

 

I agree to the above terms and conditions:

 

PARENT/ GUARDIAN NAME: ___________________________ SIGNATURE/DATE: __________________/______

                                                             

Instructions:  Give completed form and payment to your PlyoCity representative or mail to:

931 Cabernet Dr., St. Louis, MO 63017