Secure Online Registration / Waiver

Session #     

Full Name:     

Street Address:      

City:        State:        Zip:     

Home Phone:        Cell Phone:      

Date of Birth:        Email Address: 

Parent Names:

Credit Card   CC Card Number:      Expiration Date:       

Security Number (last 3 digits on back of card, on signature line)     

Parent Authorization / Waiver

Please read this information:

We the parent(s) or guardian(s) of the above named player/student give my/our approval to participate in this program.  We give our permission for emergency medical authorization in the event that we cannot be reached.  We also do hereby waive, indemnify and agree to hold harmless Pro Player Consultants, Inc. and it's staff, sponsors, officers, owners and participants for any claim arising out of an injury to my / our child.

Click this box to indicate that you have read the above statement and agree with it in its entirety.