PSTA Registration Form

POWER STEP TACKLING ACADEMY REGISTRATION
Quick Question

Please answer the question below before you get started.
YesNo
Athlete Information

Please enter the following information regarding the athlete participating in PSTA.
Athlete Name*

First NameLast Name
Athlete Age*
5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeOther
School/Team Athlete Plays For*
Youth athletes only enter team please.
Parent/Guardian Information

Please enter parent/guardian information below (if under 18).
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone

Area CodePhone Number
Parent/Guardian Email
example@example.com
Medical History

Please enter any allergies or significant medical information below.
Medical Information and/or Allergies*
If athlete does not have any important allergies or medical information that needs to be shared, please enter "None".
Emergency Contact

Please enter two emergency contacts.
Emergency Contact Name 1*

First NameLast Name
Emergency Contact Phone 1*

Area CodePhone Number
Emergency Contact Name 2*

First NameLast Name
Emergency Contact Phone 2*

Area CodePhone Number
Session Dates

Please select the session date(s) you or your athlete will be attending.
Session 1 - April 26th, 2026Session 2 - May 3rd, 2026Session 3 - May 17th, 2026Session 4 - May 31st, 2026Session 5 - June 7th, 2026Session 6 - June 14th, 2026Session 7 - June 28th, 2026Session 8 - July 5th, 2026Session 9 - July 12th, 2026Session 10 - July 19th, 2026Session 11 - July 26th, 2026Session 12 - August 2nd, 2026
Payment

Please select the number of sessions you would like to purchase.
PrepaymentWalk-up
1 Session - $75.002 Sessions - $150.003 Sessions - $225.004 Sessions - $300.005 Sessions - $375.006 Sessions - $450.007 Sessions - $525.008 Sessions - $600.009 Sessions - $675.0010 Sessions - $750.0011 Sessions - $825.0012 Sessions - $900.00
Prepayment Options

Please use the options below to prepay for your sessions.

Products and Payment*

After choosing your package and entering payment information above, complete your form by reading the "Release of Liability" below and agreeing to the Conditions and Code of Conduct at the bottom of the page.
Release of Liability

Please carefully read all content below.
Code of Conduct

Please carefully read all content below.
How Did Your Here About Us?

We would like to know how you found out about Power Step Tackling Academy. Please answer the question below.
Social MediaFrom Someone I KnowCoachYouth Football OrganizationPower Step Tackling Academy VanOther
Signature*

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POWER STEP TACKLING ACADEMY REGISTRATION

Quick Question

Athlete Information

Parent/Guardian Information

Medical History

Emergency Contact

Session Dates

Payment

Prepayment Options

Payment Methods

Release of Liability

Code of Conduct

How Did Your Here About Us?