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Speed 4 Sport
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Speed 4 Sport
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Parent/Guardian Information
Parent/Guardian's First Name:
Parent/Guardian's Last Name:
Phone Number: Email:
Home Address:
City: State: Zip:
 
Athlete Information
First Name: Last Name:
T-Shirt Size: Gender: Birthdate:
Session Type:
 
Insurance Information
Insurance Carrier:
Insurance Policy Number:
Speed 4 Sport

 

*If I cannot be reached in case of emergency, I authorize all medical procedures performed or prescribed by a physician for myself or my child. I hereby wave and release Speed-4-Sport, its employees, agents, facilities, and representatives from any and all liability for any loss or injury sustained or incurred while myself or my child participates in any form of private or group training program, or while traveling to or from this program. By submitting this form, the guardian and participant both agree to the above statement.

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