Clone of Lift Lab Membership

Elite Coaching. Proven Development.

Ages 10+

Practice/Training Days: Monday, Tuesday, Thursday 8:00-10:00 AM

Locations to be announced at later date.

June-August

$500 for summer

Questions: dustinallen75@icloud.com

Athlete Information

Athlete's Name*

First NameLast Name

Age*

Birth Date*

MonthDayYear

Grad Year*

Primary Event

New to track & field? Don't have to answer.

Parent/Guardian Information

Name*

First NameLast Name

Cell Number*

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

As the legal guardian of the participating minor, I acknowledge that I have been comprehensively informed of the activities and potential risks associated with the Roe Pro event designed for youth. I understand that while every measure is taken to ensure the safety of participants, there remain inherent risks associated with any physical or sports-related activity. These may include, but are not limited to, minor injuries, strains, discomfort, or in rare instances, more severe consequences.

I hereby affirm that the minor for whom I am the legal guardian is physically and mentally fit to participate in the activities linked to this event. I accept the responsibility of determining if the minor is sufficiently fit and healthy for involvement in this event.

By signing this document, I expressly and voluntarily assume all associated risks on behalf of the minor and waive any and all claims, liabilities, or demands that may arise as a result of injury or damages sustained during participation. This waiver extends to Roe Pro Fitness & Athletics, their staff, trainers, volunteers, affiliates, or any third parties acting on their behalf.

I confirm that I have read this Informed Consent and Acknowledgement for Minors in its entirety, understand its contents, and consent to its terms willingly on behalf of the minor.

Medical Release and Authorization

As the Parent and/or Guardian of the child, I authorize the diagnosis and treatment by a qualified and licensed medical professional for the minor child in the event of a medical emergency. Such situations may require immediate action to prevent further harm to the minor’s life, avoid physical disfigurement or impairment, or mitigate any undue pain, suffering, or discomfort if treatment is delayed.

I grant permission to the attending physician to carry out any medical or minor surgical treatment, x-ray examination, and immunizations necessary for my child. Should there be a critical situation arising from severe illness, the necessity for major surgery, or significant accidental injury, I acknowledge that the attending physician will make all reasonable efforts to contact me swiftly.

Furthermore, I grant permission to Roe Pro Fitness & Athletics, and their respective affiliates, including but not limited to Trainers, Coaches, and Volunteers, to provide essential emergency treatment for the child before being admitted to a medical facility.

This authorization is valid for the dates and/or duration of the registered season.

I willingly provide this release with the primary intention of ensuring medical treatment in emergency circumstances for the safety and welfare of the named minor child while I am not present.

Media Release Authorization

By registering with Roe Pro, all participants and their legal guardians hereby grant Roe Pro, its representatives, and employees the right to take photographs and videos of the participants in connection with sports activities. These photographs and videos may be used for promotional, marketing, and other related purposes on Roe Pro's official social media channels, website, and other digital and print platforms without any compensation to the participant or their legal guardians. By completing the registration, participants and guardians acknowledge that they have read and understand the above provision and grant Roe Pro the unrestricted right to use said media.

Your reservation isn't confirmed until there's an e-signature below...

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Program Selection*

Summer Track Registration$500.00

Credit Card

Parent/Guardian's Signature*

Elite Track & Field Registration

Credit Card