Thank you for registering your child for our 2017 Parisi Speed School Summer Camp!  Please take a few minutes to complete the following Application so that our coaching staff will have all the required information we need for your child.  If you have any questions, please feel free to contact us:  info@parisixpc.com or 321-610-3928.

Athlete Name *
Athlete Name
Date of Birth *
Date of Birth
MM/DD/YYYY
Address *
Address
Parent Name *
Parent Name
Parent Cell Phone *
Parent Cell Phone
Sports Played
Camp Location/Date Purchased *
I hearby give consent for my child to participate in the Parisi Speed Camp. I assume all risks with regard to my child’s participation in these activities. I release, indemnify, and agree to hold harmless the Parisi Speed School, XPC Training Systems, Inc., it’s directors, owners, trainers, and volunteers from any liability that may result from participation. By my signature, I attest to the following: That the information provided below is correct, and in the event of a medical emergency, I authorize the Parisi Speed School, XPC Training Systems, Inc. and/or their respective staffs to seek medical care for my child as deemed necessary. I certify that I am the Parent/Guardian of the above mentioned athlete and am over 18 years old and agree to the conditions specified above.
IN ADDITIONAL CONSIDERATION OF BEING PERMITTED BY THE PARISI SPEED SCHOOL TO PARTICIPATE IN ITS TRAINING PROGRAM AND TO USE ITS FACILITIES, I HEREBY PERMIT THE PARISI SPEED SCHOOL TO USE MY NAME, IMAGE AND LIKENESS FOR PROMOTIONAL PURPOSES LIMITED TO ITS ATHLETIC TRAINING PROGRAMS AND FACILITIES. THE PARISI SPEED SCHOOL’S PROMOTIONAL MEDIUMS INCLUDE BUT ARE NOT LIMITED TO PRINT, RADIO, VIDEO, TELEVISION AND THE INTERNET. I ACKNOWLEDGE THAT I HAVE READ THIS RELEASE AND WAIVER AND FULLY UNDERSTOOD ITS CONTENTS. I HAVE BEEN FULLY AND COMPLETELY ADVISED OF THE POTENTIAL DANGERS INCIDENTAL TO ENGAGING IN THE ACTIVITY AND INSTRUCTION OF ATHLETE TRAINING AND I AM FULLY AWARE OF THE LEGAL CONSEQUENCES OF SIGNING THIS RELEASE. I VOLUNTARILY AGREE TO THE TERMS AND CONDITIONS STATED ABOVE.
Electronic Signature
BY PRINTING YOUR NAME BELOW, YOU ACKNOWLEDGE YOU AGREE TO THE TERMS SET FORTH IN THIS DOCUMENT.
Parent Name *
Parent Name
Date
Date