Coast 2 Coast Off-Ice Training Registration

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Please FILL OUT and COMPLETE the following participant/parent registration information and payment form.

READ and ACKNOWLEDGE the following training waiver, cancellation policy, AND Photo Release Section in order to train with our Coast 2 Coast trainer in the C2C gym facility.

Email *

Participant's FIRST Name: *

Participant's LAST Name: *

Participant's Birth Year (YYYY):
*

Participant's #2 (SIBLING) FIRST Name:

Participant's #2 (SIBLING) LAST Name:

Participant's #2 (SIBLING) Birth Year (YYYY):

Participant's #3 (SIBLING) FIRST Name:

Participant's #3 (SIBLING) LAST Name:

Participant's #3 (SIBLING) Birth Year (YYYY):

Parent/Guardian's FIRST and LAST Name (if participant is UNDER the age of 18):
*

Emergency CONTACT number (XXX) XXX-XXXX:
*

List any MEDICATIONS or MEDICAL CONDITIONS we should be aware of regarding your player/players. (Ex. Asthma)
*

For MODIFICATION purposes, list any MEDICAL LIMITATIONS we should be aware of regarding your player/players.
*

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