PHENOM ATHLETES PROFILE SHEET SECTION ONE. Personal Information. Physical Information. Athlete s History. Goals. Client Name: Address:

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1 PHENOM ATHLETES PROFILE SHEET SECTION ONE Personal Information Client Name: City: State: Zip: Date of Birth: Age: Place of Birth: School: Grade: Physical Information Height: Weight: Shoe: Shirt: Pants: Athlete s History Medical History: Injuries: Y N Surgeries: Y N Allergies: Y N Special conditions: Y N If you check yes to any of the above, please provide a brief description: Years of experience in athletics: Sport Accomplishments: Goals Favorite Colleges: Sports Goals:

2 PHENOM ATHLETICS RELEASE OF LIABILITY FORM Name: Date of Birth: Age: Place of Birth: School: Grade: Participation Consent I hereby authorize my child, full participation for athletic training with Phenom. I further agree to release Phenom, it s coaches, volunteers, or board of directors from any liabilities and/or obligations for the conduct or any loss, damage or personal injury to my child. Further, I understand my child is required to participate in the fund raising programs designed to help with the overall cost for participating throughout the entire year. Medical and Liability Release In the event of an accident or emergency, I authorize a coach or volunteer of the Phenom Organization to call for the necessary medical attention. I further agree to allow Phenom to personally transport my child to the nearest known hospital and I agree not to hold Phenom, it s coaches, volunteers, and board of directors liable for any damages, loses, or injuries to the individual named above, or to person/s or property or the undersigned related to the transport of the minor and the emergency procedure. Furthermore, I agree to assume and accept all responsibility for the emergency treatment or measures that are deemed necessary for the safety of my child. The parent, guardian, or individual responsible for the minor listed on this form understand that they are signing on their own behalf and on behalf of the minor listed on this form, and that the signature is for both a medical and liability release. This Medical and Liability Release shall remain effective for all activities. Medical Information: Hospital Insurance: Y N Family Doctor: Insurance Company: Policy Number: Primary Emergency contact: Secondary Emergency contact: Medical conditions, allergies, medications, devices and past major injuries or surgeries: Parent or Guardian Signature: Date: YOUR CHILD IS REQUIRED TO ALWAYS HAVE THE PROPER TRAINING GEAR

3 PHENOM ATLETHICS SPEED & AGILITY CERTIFICATION REQUIRED: Physical Release Form signed by Physician Medical and Liability Release Form signed by Parent or Guardian Profile Information Sheet Promise to Pay Contract

4 PHENOM ATLETHICS SPEED & AGILITY Parent Information (if client is under age of consent) Name: Driver s License: Parent and/or guardian agrees to pay the dues or other payments required to pay under this agreement if client is under the age of eighteen. The person whose name appears in section one of this form applies for membership with PHENOM ATHLETICS Speed and Agility program (and/or staff) on terms set out in this contract agreement. This document is an application for PHENOM ATHLETICS Speed and Agility program related training services and will form an agreement between the Client and PHENOM ATHLETICS. I, PHENOM ATHLETICS OWNER, will make no representation or warranties, written or oral, expressed or implied, other than those in this agreement. Number of months = (Three {3} month minimum) Cost per month = Total cost = Bill : MONTHLY PAID IN FULL Please check this box if you would like to receive your monthly invoice via . Upon default in any of the above payments, PHENOM ATHLETICS may at its option and upon ten days written notice to the CLIENT declare the whole or any part of the balance less any unearned credit charges to be immediately due and payable. The Client agrees to pay interest on all overdue amounts under this agreement at a rate of 2% per month (24 % per year), calculated and compounded monthly in arrears from the date that the amount is due, and service charges of $25.00 on each check or other payments which is not honored or made by the Client s bank and savings institution. Administration fees are non-refundable.

5 Promise to Pay The Client hereby promises to pay PHENOM ATHLETICS dues in the amount of $ per month hereinafter referred to as Dues, and said Dues are to be paid the day of each month, commencing. I, PHENOM ATHLETICS OWNER, may cancel the Client s right for PHENOM ATHLETICS Speed and Agility program if the Client fails to pay his/her Dues within 10 days from the date they are payable. However, the Client agrees to pay a minimum of three (3) months of guaranteed Dues and no portion of this is canceled or refundable. I, PHENOM ATHLETICS OWNER, with my discretion, may re-admit the defaulting client for my PHENOM ATHLETICS Speed and Agility program. In certain circumstances (at the sole discretion of PHENOM ATHLETICS OWNER) the client is not able to commit to the full agreement; the member is responsible for all training sessions to be paid up to date. Under this circumstance, payment arrangement will be made available. Assignment The Client acknowledges and agrees that this Agreement and Promise to Pay may be assigned by PHENOM ATHLETICS OWNER at its sole option to a third party, provided that the Client shall receive notice in writing of any such assignment. The Client acknowledges receipt of a copy of the agreement, acknowledges having read and understood its terms and agrees to be bound by its terms contained in this document. Notice of Right of Cancellation This is a contract to which the Consumer Protection Act of California applies. You, the Client, may cancel this contract by giving notice of cancellation not later than 10 days after the date of execution of the contract. It is not necessary to give reasons for the cancellation. In order to cancel the contract, the Client must give notice of cancellation by a method that will allow you to prove that you gave notice, including or personal delivery of notice within this 10 day period. PHENOM ATHLETICS commitment confirmation; Name. (print) Signed Parent or Guardian (if necessary) Witnessed by Date of Acceptance