West Coast Kinesiology Conditioning Waiver/Registration Form


One form is required for each player. West Coast Kinesiology Conditioning Programs reserves the right to regroup or reschedule participants based on
ability and enrollment.Please print a copy of this form and the medical form, fill them out and bring them to your first session.

Name _____________________________________________________ Phone _____________________
Address __________________________________________________ City _______________
Postal Code________________

Birth Date __________________ Age _______ Male____ Female____
Care Card #_______________

I’ve been playing ___________________(my sport) for_____ years.
Position: ________________________________________________

How did you hear about the West Coast Kinesiology Conditioning Program? ____________________________________________________________________.

We the applicant and his/her parents or guardians agree that West Coast Kinesiology Services Ltd. and its directors and instructors, employees or volunteers are not liable for, nor held responsible for any accident or loss however caused and agree to release same from all claims or damages, now and at any time in the future. We further agree that the applicant has no medical problems and is in good physical health and that we will be responsible for all medical and dental claims and/or insurance. West Coast Kinesiology Services Ltd reserves the right to use any photos or written testimonials taken during the programs for advertising and /or instructional purposes. Players are expected to conduct themselves in an appropriate manner at all times. Failure to do so could result in removal from the program. I have read and understood this form and indicate this by my signature below.

Participant Signature ________________________________________________

Parent or Guardian Signature _________________________________________
(If participant is under 19 years old)

Date _______________________________

Please check box if you would like to be included on our email list.

My email address is:_________________________________________

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