Registration - Momentum Youth Sports Training

Back to Basics Registration

Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Date of Birth *

Age *

Parent Name *

First

Last

Email *

Phone

Emergency Contact Person *

First

Last

Phone

Would you like to be added to our e-mail list?

We occasionally film our training sessions. Do you give permission for your child to be in photos or videos?

Session *

Total

$0.00

Payment method

Please check one.

Medical Release and Authorization

Informed Consent and Acknowledgment

Click yes if you agree to the above terms and conditions.

Signature

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