Registration Form

Name *
Name
Phone *
Phone
Address *
Address
Birth Date *
Birth Date
Parent Guardian Name
Parent Guardian Name
If Under 18 Years of Age
Parent Guardian Phone
Parent Guardian Phone
If Under 18 Years of Age
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Primary Physician Phone *
Primary Physician Phone
Programs *

Liability Waiver

I certify and acknowledge: 

That Clayton Conditioning, has advised me prior to my commencement of participation in any/all dryland or on-ice programs offered by Clayton Conditioning that such participation could result in physical injury. 

That I freely and knowingly assume the risk of such programs, and I hereby waive any right, claim, or cause of action against Clayton Conditioning and release him/her and/or his/her company from any liability for any injury, cost, damage expense or claim, which I or anyone on my behalf might incur as a direct or indirect result of my participation in any/all dryland or on-ice programs. 

That I have read this Liability Waiver form and understand and agree with each of the foregoing points. 

*
Name *
Name
Date
Date