Athlete Name
full name
Athlete Date of Birth
Athlete Age
Primary Sport
Gender of Athlete
Parent / Legal Guardian (if athlete is a minor)
full name
Address (line 1)
Street
Address (line 2)
City
State
Zip Code
Phone Number
Email
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Medical Conditions
Does athlete have any medical conditions that could be affected by exercise?
Yes
No
If you answered "Yes," please describe.
I / We Accept and Consent
Yes
No
Submit