Welcome to the Quarterback Combine: Youth registration

Quarterback Combine Youth Registration - California

SESSION A:

SESSION B:

Athlete Information:

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&B) Block Sessions.

Athletes name:

Athletes School:

Athletes DOB:

Athletes Grade:

Athletes Position:

Athletes Height:

Athletes Weight:

Athletes Insurance Co:

Athletes Insurance Policy No:

Athletes email address:

Athletes phone number:

Athletes Cell:

Referred by:

Select SESSIONS:

PARENT INFORMATION

Parent Name:

Parent Cell:

Parents Email Address:

Address:

City:

State:

Zip code:

PAYMENT OPTIONS

Master Card

Visa

American Express

Check

Credit Card Number:

Expiration date:

CARD SECURITY CODE:

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

I have read and agree to the above terms:

Mandatory Medical Waiver

Wide Receiver and Running Back
sessions are available.

Sessions: BLOCK B
TBA

Sessions: B TBA

Sessions: A
10 Sessions      $1,000.00

January 14, 21,   28
Feburary 4,   11, 18, 25
March    3 , 10

TIME:
8:00am - 11:00 am Saturdays

Location:
Santa Monica College   SMCC
1900 W Pico Blvd
Santa Monica Ca 90405

Sessions: BLOCK A
(Saturday Daytime Sessions)
January 14, 21,   28
Feburary 4,   11, 18, 25
March    3 , 10

TIME: 8:00am - 11:00 am Saturdays
Location: Santa Monica College   SMCC
1900 W Pico Blvd
Santa Monica Ca 90405

High School & Youth Sessions
Start January 14 2012