Welcome to the Quarterback Combine!

Quarterback Combine HS Registration & Fees for California

SESSION INFORMATION
The day you start a session will be
considered the first session.
If a session is missed, it is agreed
that (the missed session) will count
as a session.

You may enroll the athlete in
(2) (A and B) Block Sessions.

SESSIONS   A

DATES:
January   14, 21, 28
Feburary   4,   11 , 18,   25
March   3,   10
NOTE: March 3, Double Session: Long Beach
Poly Event Challenge

Time: 8:00 am - 11:00 am Saturdays

LOCATION: Santa Monica College     SMCC
              1900 W. Pico Blvd
              Santa Monica Ca.   90405

Mandatory Medical Waiver

Athlete Information:

Athletes name:

Athletes School:

Athletes DOB:

Athletes Grade:

Athletes Position:

Athletes Height:

Athletes Weight:

Athletes Insurance Co:

Athletes Insurance Policy No:

Your email address:

Your phone number:

Cell:

Referred by:

Select Level:

Select SESSIONS:

See Session descriptions in left column

See Level descriptions above

PARENT INFORMATION

Parent Name:

Address:

City:

State:

Zip code:

PAYMENT OPTIONS

Master Card

Visa

American Express

Check

Expiration date:

CARD SECURITY CODE:

Credit card number

ON BACK OF CARD

Name: as appears on card:

Address:

City:

State:

Zip code:

AGREEMENT: This agreement shall be binding upon both parties and or any responsible party. QB
Combine accepts credit cards, money orders, checks or cash. Clients will be charged a $75.00 return
check fee and possible cancellation of the athlete to attend the combine. It is agreed that the Client
or responsible party for the Client will carry his own insurance. Parents release, hold harmless and
waive any and all responsibility of the QB Combine/TOPGUN Combine, any and all facilities used,
the staff or city in regards to the athlete in any way. This agreement constitutes the entire
understanding between the parties. A waiver of breach of any provisions and acknowledgements of
the rules of this agreement shall not be construed as a continuing waiver of other breaches of the
same or other provisions hereof. This agreement shall be governed by the laws of the State of
California. The total information input on this form from the athlete and the responsible party for
the athlete give authorization for the Client named above to participate in all aspects of the
sessions of the QB Combine/ TOP GUN Combine. It is agreed that the client or the responsible
party of the client acknowledges and agrees to all conditions of the Medical Waiver. Photos and
video taken of the Combine and athletes are the sole ownership of the Quarterback Combine which
is authorized to use for their web site or promotions.

Submitting online agrees to all conditions. (NO REFUNDS).
By submitting on line, constitutes my signature and authorization to the agreement stated, all
provisions and authorization for the Quarterback Combine to charge the credit card information
input for training fees selected. Discounts will be deducted automatically before the credit card
information is processed.
We accept: MASTER CARD, VISA & American Express
3% Credit card process fee will be added

Mandatory Medical Waiver

Medical waiver must be signed and submitted.

I have read and agree to the above terms:

SESSION B TBA

SESSIONS - TIMES - LOCATIONS

All Level Packages available in "A" or "B" Sessions (OR BOTH)

Sessions: A
SESSIONS   A

DATES:
January   14, 21, 28
Feburary   4,   11 , 18,   25
March   3,   10
NOTE: March 3, Double Session: Long
Beach Poly Event Challenge

Time: 8:00 am - 11:00 am Saturdays

LOCATION:
Santa Monica College     SMCC
1900 W. Pico Blvd
Santa Monica Ca.
90405

Sessions: B
DATES: TBA
Location: TBA

SESSIONS - TIMES - LOCATIONS

California Combine Registration

High School & Youth Sessions
Start January 14 2012