Program Registration | Kyeropractic Performance

2024 QB Performance Program Registration

IMPORTANT: YOUR SPOT WILL NOT BE SAVED UNTIL PAYMENT IS SUBMITTED

Step 1: Complete Registration

Athlete's First Name

Athlete's Last Name

Phone Number

Grade

Please list all injuries you have suffered (if applicable)

Parent/Guardian Name

Parent/Guardian Phone Number

Emergency Contact Information

Is the athlete prescribed an inhaler?

If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by this organization, during the selected camp. In exchange for the acceptance of said child’s candidacy by this organization. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless this organization. All its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against the organization. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including football. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.

Confirmation

By acknowledging and entering name and initials below, I am delivering an electronic signature that will have the same effect as an original manual paper signature.

Full Name

Initials

Step 2: Submit Payment

Clicking the Pay Now button will take you to the payment page.