Summer 2019 Youth S&C Clinic


Early Bird Special:

Sign up by April 30th

Receive 10% off

Mary’s Fitness; LLC

Entry Form

Name:__________________________    Address: _____________________

Email: __________________________   Phone Number:___________

Emergency Contact: _______________  Emergency Number:___________

Athlete’s Age: ___   M___   F___ Shirt size: Youth: ____   Adult: ____

Circle weeks wanting to attend:

Whole Clinic:                          __$380__

First 3 Week Session             __$230__

Second 2 Week Session          __$150__

Week of:         June 10:           __$80___                                July 8:             __$80___

                           June 17:           __$80___                                July 15:           __$80___

                           June 24:           __$80___

Total Enclosed: _________

Waiver: To participate in the Speed, Agility & Conditioning Clinic, June – July 2019, offered by Mary’s Fitness, LLC; I do hereby waive, release and discharge Mary’s Fitness, LLC, and its representatives and others acting on their behalf from any and all claims of liabilities for injury or damages to my person and/or property including those caused by negligent act arising out of or connected with my participation in this clinic. I understand that failure to comply with the rules of the clinic may result in expulsion from the clinic and forfeiture of entry fees. I grant by irrevocable permission to Mary’s Fitness, LLC, to use my name, any photographs, video tapes, recordings or any records of my participation in this clinic.

Printed Name: ___________________________      Date: ______________

Signature of parent or guardian for participant under 18 years old

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