Training Registration Form

 Contact Information:

I would like to participate in the following sponsored activity/event hosted/run by Speed Matters (check activity that applies):

December Body Sculpting at Cornerstone Church in Cranberry Twp. (3 PM | 12 Sessions = $109)
December Body Sculpting in Cigna Fitness Room (3PM Sessions | 12 Sessions = $109  or  16 Sessions = $129)
January SV Girls Lacrosse Team Speed and Conditioning Camp (Weekdays 3:00 PM/Sat. 9:00 AM | 10 Sessions = $95)
January SV Boys Lacrosse Team Speed and Conditioning Camp (Thurs. 4:30 PM/Sat. 12:00 PM | 14 Sessions = $119)
January SV Youth Boys Lacrosse Team Speed and Conditioning Camp (Thurs. 5:30 PM/Sat. 1:00 PM | 8 Sessions = $79)
January Boot Camp at Cornerstone Church in Cranberry Twp. (5:30 AM | 16 Sessions = $129 or 32 Sessions for $238)
January Boot Camp at Cornerstone Church in Cranberry Twp. (12 Sessions = $109 or 16 Sessions for $129)
January/February Stars United Soccer Club Speed and Agility Camp (8 Sessions = $95)
January/February Chartiers Valley Youth Girls Lacrosse Sessions (6 Sessions = $59)
   
 
Participant's Name:
Name of Parent/Legal Guardian:
Age of Participant:

Grade Level of Participant:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email Address:
Camp/Clinic Dates:

Birthday
(mm/dd/yyyy)

How did you hear about us?:
Newspaper  Referral/Friend  Clipper Magazine  Internet
Other:

Would you like more information from our sponsors?:
Yes  No
 

Waiver – Electronic Signature Required

 

Liability Release. In consideration of being allowed to participate in the Pre-Season Sport Specific Clinic, I acknowledge and agree as follows:

 

I acknowledge that participating in the pre-season clinic is a potentially hazardous activity.  Some risks I may encounter include but are not limited: contact w/ other participants, exhaustion or dehydration, or any other sport/fitness related injuries.  I agree to assume all risks of personal injury involved in undertaking of this activity and fully assume any and all risks of personal injury by enrollment in this event/clinic of the Sport Specific Training Clinic, Robert Naylor, CEO Speed Matters.

 

I, in my own and on behalf of the Minor, further agree to release and hold harmless Speed Matters and their respective attorneys, employees, director, sponsors, and if applicable, owners and lessors of premises used to conduct the clinic/session (hereinafter collectively referred to as “releasees”) from any and all liability for negligence or any other claim, judgment, loss, liability, cost and expenses (incl., with out limitation attorney fees and costs) arising out of or connected with any activities associated with the clinic.

 

In consideration of the promises of the herein and the use of any , I agree the risks of this event and hereby release and waive any and all claims which may arise as result of the Speed clinic.  I acknowledge that by signing this release that I waive any and all rights and claims against Speed Matters, Director of the clinic Robert Naylor.

 

I agree that all disputes arising under this release and / or for my use of the facilities contracted by Speed Matters be litigated exclusively in the court of Common Please of Alleghany County or in the United States District Court of Western Pennsylvania.

 

Legal Guardians agree to these terms and agree to waive any claims of loss of consortium and accept financial responsibility for all medical costs and other expenses arising from an injury and further more that persons agree to hold harmless and indemnify Robert Naylor as stated above under this agreement as well.

 
Electronic Signature of Participant or Parent/Guardian of Participant (Check box and type name in CAPS):
 

Date:
 
  
 

Rob Naylor
412-398-1135
www.Speedmatters.biz
fitness4less@hotmail.com