Trial Waiver
Date____________ Referred By______________
Individual Waiver
Athlete Name_______________________________________Age__________Grade________
Address________________________________________City_________________Zip_________
Telephone_________________________________ Birth Date___________________________
School Athlete Attends__________________________________________________________
Parents Name____________________________________________________________________
Telephone_________________________________EMAIL________________________________
Emergency Contact Name______________________________Telephone______________
Would you be interested in a Complimentary Individual Trial? Y____ N____
Release of Liability:
I hereby waive and release for myself and my heirs, any and all rights or claims I may have against Velocity Sports Performance, any school or facility in which Velocity Sports Performance programs are conducted and each of their respective agents, employees, servants, officers, directors, and representatives, for injury or illness arising at the physical location of Velocity Sports Performance in Mount Pleasant, SC or a program site connected with my participation or my son/daughter’s participation in Velocity Sports Performance programs. I further agree to indemnify and hold harmless of each said persons or property, which may arise by virtue of my participation or my child’s participation in Velocity Sports Performance.
Athlete Name___________________________ Athlete Signature__________________________________
Responsible Party’s Name_______________________ Signature__________________________________
(Please sign here if athlete is under the age of 18)
Relationship to Athlete_______________________________________________ Date_________________
Velocity Sports Performance – Mount Pleasant, SC
411 Wando Park Blvd.
Mount Pleasant, SC
843-284-1395
www.velocitysp.com/mountpleasant