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Memorial Day Clinic Registration

Registration form for Memorial Day Clinics.

May 23 to 27

Child Information

Name of person being registered for class.

Please list any allergies of medications

Please enter grade level, if applicable

Contact Information

Enter the e-mail address

Name of person to contact in event of emergency

Phone number of emergency contact

Class Information

Classes from May 23 to 27, 2008

Please select the class(es) you are interested in.

Please select the class(es) you are interested in.

Please select the class(es) you are interested in.

Payment Information

Please enter your preferred method of payment.

Agreement

Please read the following important information and signify your agreement by checking the button below:

I, the parent of the registrant, a minor, agree that the registrant will abide by the rules of Unlimited Sports Action. Recognizing the possibility of injury associated with sports, I hereby release, discharge and/or otherwise indemnify Unlimited Sports Action, it's staff, sponsors, employees -- including the owner of the facility -- against any claim by, or on behalf of, the registrant as a result of the registrant's participation in USA programs. I understand that participation in sports involves risk of serious injury, including permanent disability or death, and severe social and economic losses that might result not only from the participant's action but the action or inaction of others.
© 2008 Unlimited Sports Action. All rights reserved.