Training

Please select any additional training/specify training type.

Individual Training

Small Group Training

Player Name *

First Name

Last Name

DOB *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Parent/Guardian Name (Emergency Contact) *

Must be 18+ y/o.

First Name

Last Name

Primary Parent/Guardian Phone (Emergency Contact) *

(###)

###

####

Parent/Guardian Name 2

First Name

Last Name

Parent/Guardian Phone Number 2

(###)

###

####

WAIVERS *

Check each box to agree to the waiver. All three waivers must be read and agreed to in order to participate. No need to print; Please understand that checking the box acts as your electronic signature.

I have read and agree to the EASTSIDE EMPIRE WAIVER

I have read and understand the CONCUSSION WAIVER

I have read and understand the SUDDEN CARDIAC ARREST INFORMATION SHEET