Name of Athlete Participating *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian Name (if participant is under the age of 18 years old)

First Name

Last Name

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am the parent/guardian of the child register herein. I understand and agree to the terms and conditions listed in the Training Agreement, Assumption Risk, Participation Waiver, and Video/Photo Release Statments. *

I agree to the terms and conditions

Date of Signature *

MM

DD

YYYY