This form will serve as a registration form and waiver of liability. After receiving your registration form, a CHAMP Workouts℠ representative will contact you at their first opportunity to talk to you about your specific needs and find the right athlete for you!

First Name
Last Name
Birthday	Month Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1987 1986 1985 1984 1983 1982 1981 1980
Grade
Address
City
State		Zip
Phone (Home)	( ) -
Phone (Cell)	( ) -
Email
Parent's Name
Workout Partner (Group Session)

M/F	SPORT	POSITION	TRAINING PLAN
- - - - - - - Female Male	Basketball Cross Country Football Golf Lacrosse (Women's) Soccer (Women's) Softball Tennis Track & Field Volleyball (Women's) Cheerleading		Individual Workout 5 Group Workouts 10 Group Workouts 15 Group Workouts Basketball Clinic Volleyball Clinic Soccer Clinic Softball Clinic Lacrosse Clinic

 

**For Individual or Group Workouts ONLY, please complete the following 2 sections**

Success Mentoring Topic Requests (prioritize preferences 1st-15th):
Work Hard	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Attention to Detail	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
No excuses	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Team Mentality	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Preparation	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Leadership	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Best Effort	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Persistence	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Optimism	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Set Goals	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
School & Homework	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Diet & Rest	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Commitment	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Confidence	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Character	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Please do not spend any time on mentoring
Please spend up to 50% of my time on mentoring (25% of time is standard)

Sport Specific Training Requests (list all special requests):
Fundamentals
Sport Skills:
Other:

 

Release of All Claims and Consent to Medical Treatment:

In consideration of the acceptance of my entry and application to CHAMP Workouts℠, I hereby release and hold harmless CHAMP Workouts℠, the officers, directors, staff, its employees (athletes), and all persons connected with CHAMP Workouts℠ from any liability, illness or property damage, that I sustain during my participation in this program or that is in any way related to this program. I also understand that CHAMP Workouts℠ is its own entity and is not associated in any way with the University of Oregon. I understand that this Release applies to myself, my child (if signed by a parent or guardian), and our respective personal representatives, heirs and assigns. I represent that my child or ward is adequately trained to participate in this event, and I recognize the risks of injuries accompanying such participation and that I acknowledge that this release is being relied upon by all the above persons in permitting me to participate.

I have read and consent to the Release of All Claims and Consent to Medical Treatment:

Insurance Company:	Policy #:
Signature:	Today's Date