Registration
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
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DE
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Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Additional Information:
Liability Release
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I understand there may be risk of injury associated with this activity. I agree to accept those risks and allow my child to participate. I agree to indemnify and hold harmless Athletic Perfection and their employees against any and all liability for any injury which may be suffered by my child arising out of or in any way connected with participation in the programs sponsored by Athletic Perfection.
I've read the above and agree.
Photo/Video Release
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I agree to allow Athletic Perfection to use my child in pictures for the Athletic Perfection website and other advertising purposes.
I've read the above and agree.
COVID 19( Part 1)
(Show-Hide Details)
he novel coronavirus (or COVID-19) has created a pandemic resulting in a State of Emergency in California. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and health officers have required or recommended social distancing and, in many instances, have prohibited or significantly limited the congregation of groups of people.
Athletic Perfection is complying with all mandates and taking all reasonable steps to reduce the risk of spreading COVID-19. However, this risk cannot be completely eliminated. Consequently, for the safety of our staff, athletes and parents, Athletic Perfection requires all persons participating in its activities during this pandemic to acknowledge an assumption of the risk, waive (i.e. release) liability, and agree to abide by our COVID-19 protocols, as follows:
1. I request to participate in the Athletic Perfection Program. If applicable, I am the parent and/or legal guardian of the above-named student(s)/child(ren), and I request that he/she/they be allowed to participate in the Athletic Perfection program and I give my permission for he/she/they to do so.
2. Assumption of Risk. I understand and acknowledge the risk to myself and, if applicable, my student(s)/child(ren), of becoming exposed to or infected by COVID-19 while participating in the Athletic Perfection program, which exposure or infection may result from the actions, omissions, or negligence of myself or others, including, but not limited to, other participants or employees. I assume all such risk and accept sole responsibility for any harm or loss to myself and/or, if applicable, my student(s)/child(ren), including, but not limited to, personal injury or death or related costs or expenses of any kind, that I, or, if applicable, my student(s)/child(ren), may experience or incur in connection with the Athletic Perfection program.
3. Waiver of Liability. In consideration for Athletic Perfection allowing me and/or, if applicable, my student(s)/child(ren) to participate in the program, I, on behalf of myself, and/or, if applicable, my student(s)/child(ren), hereby release and hold harmless Athletic Perfection and any officials, employees, volunteers, and/or representatives thereof, from any and all liability for any and all harm or losses arising from participation in the Athletic Perfection program, including, but not limited to, exposure to or infection by COVID-19. Further, I covenant (i.e. promise) not to sue Athletic Perfection or any official, employee, volunteer, and/or representative thereof, for any such harm or loss.
I've read the above and agree.
COVID 19 (Part 2)
(Show-Hide Details)
4. Agreement to Abide by COVID-19 Protocols. I agree that I, and/or, if applicable, my student(s)/child(ren), will not enter the Athletic Perfection facilities if I am, and/or he/she/they is/are, feeling ill, which includes, but is not limited to, the following symptoms: fever, cough, difficulty breathing, shortness of breath, chest pain, and/or bluish lips or face. I understand and acknowledge that I, or, if applicable, my student(s)/child(ren), may be denied entrance or admittance to Athletic Perfection, if I am, or he/she/they is/are, showing any such symptoms. I warrant and represent that I am not aware of any medical condition of myself and/or, if applicable, my student(s)/child(ren) which would render it inappropriate for me and/or him/her/they to participate in the program.. I agree to abide by all COVID-19 guidelines issued by the Centers of Disease Control and Prevention ("CDC"), including, but not limited to, practicing "social distancing" by maintaining at least six (6) feet away from another person who is not a member of my household. I agree to abide by the Athletic Perfection COVID-19 protocols, limitations and other COVID-19-related policies and procedures which may include hand washing requirements and temperature checks for myself and, if applicable, my student(s)/child(ren). I agree to practice good hygiene etiquette such as sneezing into my elbow, utilizing tissues, and avoid touching my eyes, nose, and mouth, and, if applicable, to instruct my student(s)/child(ren) to do the same. I understand and acknowledge that my failure to abide by and/or my failure to ensure that any student/child of mine abides by this agreement may result in me and/or, if applicable, my student(s)/child(ren), being removed from the Athletic Perfection program.
I certify that I am familiar with the contents of this Assumption of Risk and Waiver of Liability and Agreement to Abide by COVID-19 Protocols, that I have read and understand the same, and that it is my intention by my signature that it bind not only on me, but my heirs, administrators, executors, successors, and assigns, and, if applicable, my student(s)/child(ren).
I've read the above and agree.
Enter your Full Name:
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Name as it appears on card:
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Address Line 1:
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City:
State:
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DE
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GA
HI
IA
ID
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MA
MD
ME
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MS
MT
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NE
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OR
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Zip:
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