2008 Game Time Speed Enrollment form

General Information

Athlete Name:___________________________ DOB:____________ T-Shirt Size_______

Sex:_________School:_________________________Team:________________________

Sports:____________________,_____________________,_________________________

Participating In

____One-on-One            # of Sessions__________ Cost_________           

____Small Group            # of Kids________ # of Sessions_______ Cost_________

____Large Group            # of Kids________ # of Sessions_______ Cost_________

____Camp                     # of Kids ________  Cost______

Parent/Guardian Information (if athlete is under 18 years of age)

Name:____________________ Phone (H)_____________ Phone (W)___________

E-mail____________________ Phone (C)_____________

Emerency Contact

Name:___________________________ Relationship to Athlete:_________________________

Address:_____________________________________________________________________

City:__________________________ State:____________________ Zip:__________________

Phone: (H)_________________ (W)______________________ (C)___________________

Make Checks Payable to Game Time Speed 82 Blanding Ave. East Providence, RI 02914

Please read and sign the following Enrollment Form/Medical Release:

I hereby give permission for any and all medical attention necessary to be administered to myself/child in the event of an accident, injury, or illness. I authorize Game Time Speed, LLC to request medical treatment as necessary to insure the well being of my child.  I also hereby waive and release Game Time Speed, LLC and staff from liability for injuries that my occur during training.  I also understand that Game Time Speed, LLC retains the right to use photos taken during training sessions for public and/or advertising purposes.

Parent/Guardian Signature:____________________________________________Date:____________