INQUIRY FORM Parent's Name * First Name Last Name Email * Phone * (###) ### #### How Can We Help? * Single Session Monthly Member Registration Individual Training Team Academy Questions Volunteer Open Gym Child's Name * First Name Last Name Child's Grade * 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th Jersey Size SMALL MEDIUM LARGE Child's DOB * MM DD YYYY Gender * Male Female Are You Registering a Second Child? * Yes No Are You Interested in Volunteering * Yes No Maybe Additional Information Do You Need Scholarship Assistance? Yes No Experience Please list, if any, prior sports experience. Additional Comments Please list, if any, scheduling restrictions or any other consideration related to your child's participation in our academy. Hold Harmless * Read carefully and sign/initial below. Parents/Guardians are responsible for their own health insurance policy. We understand this shall relieve the Sponsor, The Academy, and all coaches from financial responsibility resulting from an injury or incident. The Academy suggests that participants have a complete physical exam before practice begins. (I)(We), do hereby RELEASE and forever DISCHARGE the said Academy and its agents, officers, and employees, from all claims, demands, damages and claims for relief on account of any and all injuries which may exist or which hereinafter arise from participating in an activity or use of the Unlimited Potential Community Life Center, even if such injury results from the negligence of The Academy, its officers, agents, and employees, or from a defect in the premises. In addition, I grant to The Academy, its representatives and employees the right to take photographs/videos of my child in connection with this program. I agree that The Academy may use such photographs/videos of my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. (I) (We), HAVE READ THIS DOCUMENT AND UNDERSTAND THAT IT IS A RELEASE OF ALL CLAIMS AND THAT ALL ABOVE INFORMATION REQUESTED IS TRUE AND ACCURATE. Yes No Thank you for your interest in The Academy, someone will reach out to you soon. We look forward to working with you!
