| Application to Attend Speed 101 Summer 2010
Speed & Agility Camp | Speed 101 involves strenuous physical workouts. As in any sports activity, there is always the possibility of injury. While Coach Verdugo and his staff are experienced physical conditioning trainers and take every precaution to assure the safety of Speed 101 participants, neither Coach Verdugo or any member of his staff can be held responsible for any injuries sustained while participating in Speed 101 activities. We (I) hereby request that you accept this applicant for the Speed 101 Summer 2010 Speed & Agility Camp, In consideration of your acceptance, we (I) hereby release Speed 101 and all its employees from all claims on account of injuries, which may be sustained by our (my) child while attending the Speed 101 Summer 2010 Speed & Agility Camp. We (I) also agree to indemnify from any claims which may hereafter be presented by our (my) minor child as a result of any such injuries. | | When: | 12 Sessions (6 weeks), every Monday and Wednesday beginning June 21st through July 28th. (June 21, 23, 28 and 30th. July 5, 7, 12, 14, 19, 21, 26 and 28th) | | Time: | 6:30 to 7:30 pm. | | Location: | La Habra High School Stadium 801 West Highlander Avenue La Habra, CA 90631 | | Cost: | $20 per session, "pay as you go" ($240 for all 12 sessions) or $220 Prepaid. (save $20 Get and get a Speed 101 T Shirt) |
Participant’s Name:__________________________________________________ Parent/Guardian Name (Printed):_______________________________________ Parent/Guardian Signature:____________________________________________ Address: __________________________________________________________ Date: ________________ Phone: ( ) _____ — __________ Email Address:______________________________________________________ T Shirt Size: □ Small □ Medium □ Large □ X Large One registration form per athlete.
Please make additional copies of this registration form as needed. _____________________________________________________ For Speed 101 use □ Pay as you go □ Prepaid: □ Cash □ Check □ CC Team: _______________________________________________________ Notes:__________________________________________________________ |