BEFORE PRINTING: right click and select  Print Preview, then at top of screen, change from “shrink to fit” to 90% view.  The form should print correctly.

Profile Information

Player’s Name:                                                                                              DOB:     /            /                                      

Sports Played: 1.                                                   2.                                                  3.                                    

Organizations: 1.                                                   2.                                                  3.                                    

Address:                                                                                                                                                          

City / State:                                                                         /                                      Zip Code:                       

Mother’s Name:                                                                                Cell #:                            Home #:           

Father’s Name:                                                                      Cell #:                           Home #:            ____

Email Address 1:                                                                                                                                             

Email Address 2:                                                                                                                                             

Emergency Contact (if different):______________________   Cell #:                    Home #:            __

 

 

Session Dates: __________ Amount Paid:_________   Location: Hampshire Dome / Tyngsboro Sports Center

      

                Time: 4pm  5pm  6pm  other:                                    T-Shirt Size (S / M / L / XL) Youth or Adult

 

Previous Injuries

Please list any previous or current injuries below and explain

Date of Injury:                              Details:                                                                                                        

Date of Injury:                              Details:                                                                                                        

Date of Injury:                              Details:                                                                                                        

Medical Conditions

Physician & Office Phone:                                                                                                                              

Medications:                                                                                                                                                    

Asthma (circle one):  Y    N    if yes, exercise induced?   Y    N

Allergies:                                                                                                                                                         

Other chronic or acute conditions:                                                                                                                  

Medical Release

The undersigned parent or legal guardian and player hereby acknowledge speed & strength training, sports participation, along with physical activity in general can cause serious injury and such undersigned hereby assume the risk of such possible injury. The undersigned also hereby agree to indemnify and hold harmless: TS Performance Training, Hampshire Hills, Hampshire Dome, Tyngsboro Sports Center, any facility/location where training is held, their directors, coaches, employees, trainers, agents, and representatives from any loss, damage, award, judgment, or other liability, however characterized, including attorney fees, resulting from injury, or damage to the property or person of the undersigned player, his or her parents, or legal guardian, resulting directly or indirectly from such player’s participation in any speed, strength, and agility; sports participation; practices, games or other events.

I hereby give my permission for emergency medical attention necessary to be administered to my child

 

_______________________in the event of an accident, injury, sickness, etc. until such time as I may be contacted.

This release is given for a period of one year from the date given below. I also assume responsibility for payment of such treatment.

TS Performance Training may also use my child’s picture and or video taken at clinics/camps for promotional purposes.

 

Parent/ Guardian Signature:                                                                                                                                            

 

Date:                         

 

Once form is completed and signed, please mail with check made out to:

 

TS PERFORMANCE TRAINING

Please mail to:

Tom Labonville

20 Clarke Farm Road

Windham NH 03087