Fill out, print this form, and bring to Registration.

Athlete Information Sheet
Personal Information
Last Name:
First Name:
Street Address: City:
Home Phone:
Cell Phone:
Email Address:
Emergancy Contact Information
Last Name:
First Name:
Cell Phone:
Medical History
Are there any other current or past medical problems we should be aware of:

Current Medications:
Medical Insurance Coverage (For Emergency Purposes Only) *Optional*
Company Name:
Policy Holder Name:
Policy Number:

Liability Release

I intend to and will engage in physical activities with Sullivan Proformance Training. I assume and accept full responsibility for any and all injuries and damages that may occur to myself in or about the facilities, and forever fully release, remise, indemnify, and agree to defend and hold harmless Sullivan Proformance. I hereby waive and release Sullivan Proformance of all liability for any illness or injury incurred while at or in transit to and from the session.

By signing below, I accept the terms outlined above. I also, by signing below, represent that I am in good physical condition and that I have no physical impairment or ailment that would prevent or make it medically unwise for me to engage in physical activity.

Client Name:

Client Signature:

Parent Name:

Parent Signature: