Middle School Football Training – Fury Performance Academy

Middle School Football Training Summer 2021

PAYMENT *

Payment

Payment Information

At the completion of this form you will be automatically redirected to PayPal for payment. You may pay utilizing your PayPal account, a debit or credit card. If you are unable to provide a credit/debit card online, you are welcome to send a check to Fury Performance at 202 Rope Mill Road, Suite B., Woodstock, GA 30188. Please make checks payable to Fury Performance and write your athlete’s name and grade on the check. You may also pay cash in person at Fury Performance. If you have any questions please call or text us at: 770.823.9831

Athlete Information

ATHLETE’S LAST NAME *

ATHLETE’S FIRST NAME *

ATHLETE’S DATE OF BIRTH *

ATHLETE’S CURRENT GRADE *

What position(s) does your Athlete play? *

Parent/ Guardian Information

PARENT’S LAST NAME *

PARENT’S FIRST NAME *

EMAIL ADDRESS *

PHONE NUMBER *

Address

Apt, suite, etc.

Country

City

Zip code

Waiver and Release of Liability

I understand that, in sports performance and football camps, there is always a risk of permanent or partial injury and/or disability. I hereby waive and release Fury Performance, the owner, employees, sponsors, and all participants directing their programs from any liability for injuries the student might incur while participating in the programs, camps, clinics, and training sessions. I certify by my signature below, that I know of no mental or physical problems that might affect the athlete’s ability to safely participate in the programs offered by Fury Performance. I further agree to be solely responsible for any medical or related expenses that arise from the athlete’s participation and/ or attendance in the programs offered by Fury Performance. I hereby authorize the coaches and/or instructors and/or management of Fury Performance to act for me in my absence according to their judgment in any emergency requiring medical attention.

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Middle School Football Training Summer 2021

Payment Information

Athlete Information

Parent/ Guardian Information

Waiver and Release of Liability

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