Building Better Bodies - Performance Specialist

Registration Form

Athlete Information
Name
Age
Height
Weight
Date of Birth	mm/dd/yyyy
Injuries
Register Me For	2010 Fall Strength for Speed Program Health & Wellness Basic Performance High Performance
Parent/Guardian Information
Parent/Guardian Name
Address
City
Zip
Email
Primary Phone
Secondary Phone
Emergency Information
Contact Name
Contact Phone
Authorization
I, the undersigned parent/guardian of agree to assume full responsibility for any risks, injuries or damages, known or unknown, which might incur as result to participating in the program. I knowingly, voluntarily and expressly waive any claim I may have against Charmas Lee or Building Better Bodies or any representative thereof, for injury or damages that I may sustain as a result of participating in the program. I, my heirs, or legal representatives forever release, waive discharge and covenant not to sue Building Better Bodies, Charmas Lee, Janice Lee, or any representative thereof, for any injury or death caused by negligence or other acts. I have read the release and waiver liability and fully understand its contents and agree to the terms and conditions as stated.
Signed by Parent/Guardian Name
Signed on Date	mm/dd/yyyy