Program Registration

Registration Page

"*" indicates required fields

Program Registration and Payment

Program Payment/Deposit*

Please select your program. After submission, you will be forwarded to PayPal for payment by credit card or PayPal funds.

Winter Training 1 Day/Wk - $200.00

Winter Training 2 Day/Wk - $390.00

Select Day

Monday

Wednesday

Athlete

Athlete's Name*

First Last

Athlete's Address*

Street Address Address Line 2 City State ZIP Code

Birth date*

Gender*

Age at Program Date*

Please enter a number from 2 to 20.

Grade in Fall

School in Fall

Athlete's Email

Athlete's Cell Phone

USATF Number

Player Position

Please indicate Gender and Birth year as "F2006" for example.

Non-Player (Yes/No)

Allergies/Medical Conditions*

Please list any allergies or medical conditions. Enter "None" if there are not any to list.

Doctor*

Insurance Provider*

Medical Insurance

Insurance Member ID*

Medical Insurance ID Number

Parent/Guardian Information

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Phone*

Additional emergency contacts, when I cannot be reached:

In addition to those already listed above, an additional contact is required by the State of Colorado Department of Childcare. The following has my permission to sign my child out from the program and may be contacted in an emergency in case I cannot be reached.

Emergency Contact*

First Last

Relationship*

Address - Emergency Contact*

Street Address City State ZIP Code

Emergency Contact eMail*

Emergency Contact Phone*

Is your child vegetarian, vegan, carnivore or omnivore?

Check any that apply.

Vegetarian

Vegan

Carnivore

Omnivore

Liability Waiver

Please review the Liability Waiver

Liability Waiver*

I have read and agreed to the liability waiver