Small Group & Private Training Online Registration

First Name:

Last Name:

Phone:

E-mail:

School/Program:

Grade (Fall 2009):

Address:

City:

State:

Zip:

Alt Phone:

Personal Information

Parental/Emergency Contact Information

Waiver

I have read, understand, and abide by the following information. My child has my permission to participate in Elite Football Academy Activities. I certify that my child has been examined by a licensed physician within the last 12 months, and is able to participate in all football related physical activities. I understand that my child may come in contact with other people and objects, and I hereby waive all rights to future claims related to such contact or injuries sustained as a result of such contact. I agree to assume any and all risks associated with my son’s participation in Training Sessions and release Elite Football Academy, its Owner, Staff, Participating Facilities, Host Schools and their respective School Districts from any and all liability related to injury or illness my son may sustain during training. I authorize Elite Football Academy, in the event of a medical emergency to transport and/or seek the necessary medical treatment for my child.

Football Information

Head Coach Name:

Head Coach Email:

Height (Inches):

Height (Feet):

Weight:

What are the skills you would like to work on:

Position:

Father/Guardian Name:

Father/Guardian Phone Number:

Mother/Guardian Name:

Mother/Guardian Phone Number:

Emergency Contact Name:

Emergency Contact Phone Number:

Insurance Carrier:

Choose Training

Thank you for completing our online registration form.  You now have the choice to pay with cash, check, or charge.  If you choose to pay with cash or check, please click the "Cash/Charge Button" and your registration form will be processed.  If you would like to pay with a charge card please click the "Credit Button" and you will be taken to the Pricing Page.   Next click the "Add to Shopping Cart"  for the training you would like, and enter your payment information.   You have the choice to pay with a Paypal account or to use a major credit card.   If you experiance any problems please contact EFA at 636.346.1371.

Payment Instructions

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