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ECB REGISTRATION FORM
*
Indicates required field
ATHLETE’S NAME
*
First
Last
PARENT OR GUARDIAN NAME (IF UNDER 18)
*
First
Last
Email
*
DATE OF BIRTH
*
Phone Number
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Choose One
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MALE
FEMALE
Choose One
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MIDDLE SCHOOL PROGRAM
HIGH SCHOOL PROGRAM
COLLEGE/ADULT PROGRAM
Interested in:
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Individual (Personal) Training
Track & Field Training
Basketball Fundamentals
Football Training
Speed & Agility
Other
If you selected other, please explain:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
EMERGENCY CONTACT
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First
Last
I, the athlete, agree with the following statements
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I am physically able to take part in the activities
I will respect the rules, other athletes, ECB coaches and staff members
Phone Number
*
Waiver
and
Release
Form
Because physical exercise can be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property.
You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage.
To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence.
I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used in a legitimate purpose by the event holders, producers, sponsors, organizers, and /or assigns.
By submitting this form, I acknowledge that I understand its content and that this release cannot be modified orally.
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