Speed & Agility Monthly - Fury Performance Academy

Phone:770-823-9831 Email[email protected]

Speed & Agility Summer Special (June 3rd -July 31st)

PAYMENT *

Payment (All payments subject to 4.5% Processing fee)

Age Group *

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 AGE *

What Sports does the Athlete Participate in? *

Parent/ Guardian Information

PARENT’S LAST NAME *

PARENT’S FIRST NAME *

EMAIL ADDRESS *

PHONE NUMBER *

Address

Apt, suite, etc.

Country

City

Zip code

Emergency Contact Information

Please name any contact other than the parent listed above to contact in the event of an emergency

Name *

Phone Number *

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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Speed & Agility Summer Special (June 3rd -July 31st)

Payment Information

Athlete Information

Parent/ Guardian Information

Waiver and Release of Liability

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