Clinic Registration Form

Parent First Name *

Parent Last Name *

Email *

Phone *

Player Name *

Player Age *

Player Date of Birth *

Player Gender *

Player Gender

Male
Female
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Player Email Address

Player Phone Number

Player Position

Social Media Handles

T-Shirt Size (Unisex shirts) *

Youth Small
Youth Medium
Youth Large
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
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T-shirts are only provided if you purchase them separately below.

Medical Conditions? If yes, please describe

List Current Medications

Allergies? If yes, please desribe

How did you hear about us? *

Which clinic(s) is this player signing up for? *

Date TBD

Please make sure to choose the appropriate time frame for your player(s) age ranges

I agree that this payment is non-refundable and may only be transferred. By providing my contact information, I agree to receive text messages and emails from the business. I agree to the linked Hold Harmless Agreement.