Junior High Sports Performance

Junior High Sports Performance - Late Winter - Registration

Required

Camper Namerequired

First Name

Last Name

Current Graderequired

Genderrequired

Boy

Girl

Junior High Sports Performance - Late WinterrequiredFebruary 24 - April 16 (Off 3/31 & 4/2) Tues/Thurs, 5:30-6:30pm CDH Weight Room

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February 24 - April 16 (Off 3/31 & 4/2) Tues/Thurs, 5:30-6:30pm CDH Weight Room

The sessions are twice a week in the evenings, where we work on our running mechanics, speed development, agility, power and strength. These training sessions are great for any athlete in-season or preparing for their upcoming season.

Student Information

Date of Birthrequired

Must contain a date in MM/DD/YYYY format

Current Schoolrequired

Parent/Guardian Information

Parent/Guardian 1 Namerequired

First Name

Last Name

Parent/Guardian 1 Cell Phone Numberrequired

Parent/Guardian 1 Home Phone Number

Parent/Guardian 1 Email Addressrequired

Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 2 Cell Phone Number

Parent/Guardian 2 Home Phone Number

Parent/Guardian 2 Email Address

Emergency Contact Information

Primary Emergency Contact Namerequired

First Name

Last Name

Primary Emergency Contact Relationship to Playerrequired

Primary Emergency Contact Cell Phone Numberrequired

Primary Emergency Contact Work Phone Numberrequired

Secondary Emergency Contact Namerequired

First Name

Last Name

Secondary Emergency Contact Relationship to Playerrequired

Secondary Emergency Contact Cell Phone Numberrequired

Secondary Emergency Contact Work Phone Numberrequired

Insurance Information

Medical Insurance Companyrequired

Medical Insurance Policy Holderrequired

First Name

Last Name

Medical Insurance Phone Numberrequired

Medical Insurance Policy Numberrequired

Medical Insurance Group Numberrequired

Physician Information

Physician's Namerequired

First Name

Last Name

Hospital of Choicerequired

Physician's Home Phone

Physician's Work Phone

Medical History

If the answer to any of the following questions (below) is yes, please describe the problem and its implications for proper first aid treatment.

Does the player have any allergies that we need to be aware of?required

Yes

Allergies 1

Allergies 2

Allergies 3

Allergies 4

Does the player have any medical conditions that we need to be aware of?required

Yes

Medical Conditions 1

Medical Conditions 2

Medical Conditions 3

Medical Conditions 4

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Payment Information

Please select a payment typerequired

Credit Card

Billing Addressrequired

Address

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Country

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Cardholder Namerequired

First

Last

Expirationrequired

Month

Year

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