Winner's Edge Sports Training - Baseball, Softball, Soccer - Huntington, NY

Class/Program

Registration Form

 

You can fill out all registration information on the computer, then print the form & sign where appropriate.

NAME:      EMAIL:

HOME ADDRESS:   APT #:

CITY:  STATE: ZIP CODE:

HOME PHONE #:      DAYTIME/WORK #:

DATE OF BIRTH:      AGE:        MALE:    FEMALE:

EMERGENCY CONTACT: PHONE:

PHYSICIAN CONTACT:  PHONE:

ALLERGIES/PHYSICIAN LIMITATIONS:

If Participant is under age 18, the following information is required:

MOTHER'S NAME:

HOME PHONE:      WORK PHONE:

FATHER'S NAME:

HOME PHONE:      WORK PHONE:

SCHOOL:

ADULT(s) and/or PERSON(s) AUTHORIZED TO PICK-UP CHILD:

Class/Program Information

STARTING DATE:

CLASS/PROGRAM NAME:  DATE:    TIME:  FEE:
$
$

REGISTRATION FEE IS NON-REFUNDABLE 

AND NON-TRANSFERABLE

TOTAL FEE:

$
Name of ONE friend that your child would like to be grouped:

We will do our best to accommodate all group requests; unfortunately requests not submitted in writing cannot be fulfilled.

Payment Information

CHECK (make payable to Winner's Edge Sports Training)

CREDIT CARD: CARD NUMBER: EXP. DATE: /

NAME (as it appears on Card):

SIGNATURE:____________________________________________________________

 

For Office Use Only

Date Received: ________  Received By: ___________________  Date Processed: ________

(Circle ONE): CASH   -   CHECK  -   CHARGE    Total Amount Paid: $__________________

Please Read and Sign at the Bottom

CANCELLATIONS, REFUNDS & MAKE-UPS
1. Winner's Edge Sports Training Training reserves the right, prior to the first class or after, to cancel a course due to insufficient registration, with full refund.
2. Requests for program refunds must be submitted no later than 2 weeks before the program begins. No refunds will be given after this date. There is a $25 cancellation fee applied to all refunds.
3. Winner's Edge Sports Training is responsible for make-up classes only if a cancellation is due to the absence of the instructor or the closing of the Winner's Edge Sports Training Training facility. If you miss class, Inquire about the programs make up policy. Unfortunately we do not offer make-ups for holiday bonanzas or summer camp programs.

MEDICAL & PHOTO RELEASE:
PARTICIPANT / PARENT, PLEASE READ CAREFULLY AND SIGN WHERE INDICATED BELOW FOR ANY STUDENT PARTICIPATING IN A CLASS:
By the very nature of the activity, sports carry a risk of physical injury. No matter how careful the participant and the coach are, risk cannot be eliminated. The risk of injury includes minor injuries such as bruises and more serious injuries such as broken bones dislocations and muscle pulls. I certify that the enrollee has no condition that prohibits full participation in the activities at Winner's Edge Sports Training Training.

I understand and fully recognize that my child's participation in such sport activity program carries with it a risk of physical injury. I, on behalf of myself and my child, agree that Winner's Edge Sports Training, its agents, employees, sponsors and volunteers shall not be liable to me or my child or our respective heirs or legal representatives for any injury or damage, however caused, resulting directly or indirectly from my child's participation in any Winner's Edge Sports Training' sport activity program, at any time preceding, during or after such program is in session, and I hereby waive, and release and discharge Winner's Edge Sports Training and its agents, employees, sponsors and volunteers from, any and all actions, claims and demands which I or my child may have in connection with any such injury or damage.

I understand and agree that Winner's Edge Sports Training will not provide medical or health insurance for my child, and I will make separate arrangements to secure such insurance coverage if I deem it necessary. In the event of a medical or surgical emergency, I grant permission to the physician designated by Winner's Edge Sports Training to hospitalize, secure proper treatment for, or order injections, anesthesia or surgery for, my child. Furthermore, I understand that payment for all such medical or surgical services is solely my responsibility.

I understand and accept all enrollment conditions. I authorize that Winner's Edge Sports Training has the right to use all photographs or videos taken of my child or me during camp/leagues/classes, etc. for advertising or promotional material.

I understand and comply with the rules and regulations described above.

Signature:_________________________________________________ Date:______________

 

Please Fill out this form completely. Print and mail it to:
Winner's Edge Sports Training - 156 Railroad St., Huntington Station, NY 11746  -  Phone: (631) 367-9378