Speed Assessment Camp

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Speed Assessment Camp Registration Form

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Name: *

Phone number *

Gender *

E-mail address: *

Parent's Name *

Parent's email address *

Parent's phone number *

Grade *

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I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time. I, the undersigned parent/guardian and athlete listed above, do hereby authorize the South Austin Steel Track Club coaches and /or authorized officers as Agents for the undersigned athlete to consent to Medical, Surgical or Dental Examinations, treatments

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Coach Gerald Smith 512.296.6216 GFSmith52@gmail.com Practice location Clint Small Middle School - 4801 Monterey Oaks Blvd, Austin, TX 78749

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