New Jersey Speed Training Programs, NJ Speed Training camps, The Speed Training Institute

ATHLETE #1 Name:

Age: Sport: Position:

I am registering for (please check):

_____ Tuesday, 4:00pm, Girls 10 & under     _____ Wednesday, 4:00pm, Boys 10 & under
_____ Tuesday, 5:00pm, Girls 12 & under     _____ Wednesday, 5:00pm, Boys 12 & under
_____ Tuesday, 6:00pm, Girls 14 & under     _____ Wednesday, 6:00pm, Boys 14 & under

ATHLETE #2 Name:

Age: Sport: Position:

Parent/Guardian Names:

Home
Address:

Telephone#:
Email:

Emergency Contact & Tel#:

I certify the above named applicant is emotionally ready, is in good health and has my permission to participate in this program. I understand that there is some risk in participating in running and related activities and I am willing to assume those risks. I certify that my child has no ailments or disabilities that would prevent my child from participating in the Speed Training Institute's Sports activities. I hereby agree to hold the Speed Training Institute Inc. or McLoughlin Sports Inc. and/or their agents, employees and contractors harmless from any and all claims for any injury or illness incurred by my child during participation in this program .In case of emergency, I grant my permission to have my child given emergency treatment at a local hospital. I also grant permission for any photographs taken of my child in the program to be used for future promotional use.

Parent Signature ______________________________________________________________ Date ______________

Enclosed is my check for:

$ _____________

How To Register:

1. Print out & complete this form
2. Refund Policy: Please sign up only if your child is ready to participate in the class. Refunds are given only if we cancel a class. No refunds are given for registrants proven to be too young. A credit will be issued for withdrawals made no later than 48 hours before classes begin .
3. Send completed form with payment (check made out to Speed Training Institute)
to the Speed Training Institute

Speed Training Institute
17 Division Street
Somerville, NJ 08876
Phone: (908) 393-5811, Fax: (908) 393-5810

Speed Training Institute Speed Training Registration Form

Speed Training Institute
Speed Training Registration Form