Small Group Training

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START DATE: OCTOBER 31

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Child's Full Name *

Any Health Conditions?
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Yes

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Parent/Guardian Name
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Phone # *

Current Grade *

Release of liability

I hereby promise to obey all rules and regulations of Planet Athlete. Planet Athlete will not be liable for any injuries, death or for loss of, or damage to any equipment. NO CLAIM – I hereby agree that I shall make no claim and bring no action, suit or proceedings for any and all damages, losses, liabilities or costs in any manner suffered or incurred as a result of my participating in the activities for which I have registered herein and I hereby release the permit holder, Planet Athlete and their administration, the Municipality of Durham and the owner/occupier of the facility in which I participate from any and all damages, losses, liabilities or costs in this regard. I hereby give permission for Planet Athlete to use photographs for the purpose of future marketing in either online or hard copy media.

Release of Liability Accepted: By clicking on this box you are agreeing to the release of liability statement above.
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Yes

PAYMENT INFORMATION

Cost: $150

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ko.athleticonsulting@gmail.com

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