Next Level Performance Training

Authorization Code

Participant name

Parent/Guardian E-Mail

Address

Date of birth

Emergency contact if different from parent

Name of School

Medical Insurance Company

Policy Holder's Name

Medical Doctor's Name

I accept JGSC release/waiver

Parent/Guardian name

Parent/Guardian Phone Number

City, State & Zip Code

Grade/Age

Emergency Contact Phone Number

Any restrictions on participation

Policy number

Relationship to Participant

Medical Doctor's Phone Number

I accept VK release/waiver

Thank you for registering!