Register

Parent's Name (required)

Parent's Email (required)

Contact Phone Number(s) (required)

Address (required)

Child's Name (required)

Child's Age (required)

Please list and describe any physical or mental limitations, allergies or other pertinent information regarding your child's health or please type none

Name of School, City & State, your child will be participating in our classes

If you know the day & time for the class your child will be participating, please type below.

Child's Room teacher (required)

Additional information that is important before he/she participates in our program(required)

Terms of Agreement: To the extent permitted by law and knowing the risk of this activity, I hereby release, waive and agree to hold harmless; USA Champion Kids and its coaches and agents from any and all liability arising out of my child/s participation in this program, including but not limited to, medical bills, court costs and attorney's fees, any damage to my property or the property of others or other persons.

I accept the terms of this agreement

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