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Feet and Courage: Linebacker University
You must complete payment after form submission or registration will not be sent.
CLINIC TAKES PLACE EVERY SUNDAY
YOUTH - 1:30PM-3:00PM
HS 3:00PM-4:30PM
FIELD LOCATION WILL BE EMAILED TO YOU.
Select your Session
Please select
Single Session - $40
5 Pack - $150
Private 1on1 - $55
Small Group - $45
Player Information
Player Name
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First
Last
Player Email
Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Cell Phone
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Date of Birth
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YYYY
Height
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Weight
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Name of Current School
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What team(s) do you currently play for?
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Graduation Year
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HUDL
Twitter
Instagram
Parent/Guardian Information
Guardian Name
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First
Last
Guardian Email
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Guardian Cell
*
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Medical
Each participant is required to be covered by medical insurance.
Insured Name
*
First
Last
Relationship to player
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Insurance Company Carrier & Plan or Group Number
*
Insurance ID Number
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Allergies
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Medication
*
As a participant with Feet and Courage ("Organization"), I acknowledge that participation with the Organization exposes me to a possible risk of personal injury. I, hereby release Feet and Courage (“Company”) and Gerald Filardi, its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, from any and all liability from property damage, personal injuries or other claims arising from or in connection with my participation in the Event including claims that are known and unknown, foreseen and unforeseen, future or contingent.
I covenant that I will not now or at any time in the future, directly or indirectly, commence or prosecute any action, suit or other proceeding against Feet and Courage, Gerald Filardi, and its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, arising out of or relating to the actions, causes of action, claims and demands hereby waived, released or discharged by me.
For good and adequate consideration, which I acknowledge I have received, I hereby grant, release, and quitclaim to the Company the right and authority to use, sell, reproduce, and distribute, quoted material, email address, biographical information, my photograph, likeness, recorded voice or videotaped filmed appearances obtained in connection with the Organization (the "Materials") for promotional and advertising purposes or programs as Company in its sole discretion will deem appropriate.
I acknowledge that I have read and fully understand this Player Authorization, Injury Waiver, and General Release Form. This agreement will be binding on me, my spouse, my children, legal representatives, heirs, successors and assigns.
DATE
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Player Signature
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Clear
The undersigned ("Parent"), parent of ("Player"), hereby consent to affirm, and, on behalf of Player, agree to be bound by the Injury Waiver and General Release Form attached hereto which has been signed by Player. Parents also represent, warrant and agree that Parents (is)(are) entitled to the care and custody of Player and (is)(are) Player's legal guardian(s); that during the minority of Player and for a reasonable time afterwards, Parents will use all reasonable efforts to prevent Player from attempting to or actually disaffirming the Injury Waiver and General Release Form signed by Player; that Parents hereby acknowledge that Parents have read the Injury Waiver and General Release Form and are satisfied that it is fair and equitable for the benefit of Player; and that Parents will not revoke this consent and approval.
DATE
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MM
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DD
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YYYY
Parent Signature
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Clear
