2023-24 Winter Passing Clinics

Athlete's Information

Please submit a separate form for each clinic participant

Athlete's Name *

First

Last

Birthdate *

HS Grad Year *

School or Youth Organization

Athlete's Instagram

Athlete's Twitter

Parent/Guardian Info

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Health info & waivers

I acknowledge that the above listed athlete is healthy and has been cleared by a physician to participate in physical activity consistent with football training. I hereby authorize Prime Time Sports Camps Inc. to act for the above listed athlete according to their best judgment in an emergency situation, and hereby waive and release Prime Time Sports Camps Inc., its staff and the facility from any and all liability for injuries while at the clinic. I understand that accident insurance is provided, but health insurance is not.

Health Insurance Company: *

Insurance Policy Number: *

Payment & Enrollment Information

Registration is not final until at least a deposit is received. Payments in cash/check avoid 3.5% processing fees. After registering you will receive an email with details for attending clinics and making any further payments necessary.

Team/Organization Discount Code

Only enter a code if your team or organization provided you with a discount code. Be sure to enter it correctly here to see your discounted rates on this form. Leave field blank if your team did not provide you with a code. Entering a fake or wrong code will prevent you from completing the form.

Position *

Quarterback
WR/TE/RB

Payment Options: *

Pay $50 Deposit via credit card now (processing fee applies); balance to be paid by cash/check prior to or at your first attended session
Pay in full now via credit card (processing fee applies)
mail in deposit or full payment via check

Choose the number of sessions in which you would like to enroll: *

Choose the number of sessions in which you would like to enroll: (discount pricing listed) *

Choose the number of sessions in which you would like to enroll: *

processing fee of 3.5% included in price

Choose the number of sessions in which you would like to enroll: (discount pricing listed)) *

processing fee of 3.5% included in price

Choose the number of sessions in which you would like to enroll: *

Choose the number of sessions in which you would like to enroll: (discount pricing listed) *

Choose the number of sessions in which you would like to enroll: *

processing fee of 3.5% included in price

Choose the number of sessions in which you would like to enroll: (discount pricing Listed) *

processing fee of 3.5% included in price

Click each of the sessions you plan to attend (changes can be made by notifying us in advance). Must select at least the first session you plan to attend:: *

All sessions are Wednesday nights from 6-8pm at US Academy of Soccer Bubble in Farmingdale, NY (875 Conklin St.)

Deposit

Price: $ 51.75

$50 deposit plus $1.75 processing fee

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

Signature *

I agree to health waiver stated above. I also hereby grant permission to Prime Time Sports Camps Inc., its employees and agents, to take and use visual/audio images & video of the above listed athlete. Images and videos are any type of recordings including but not limited to photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying written descriptions. Prime Time will not materially alter the original images. I agree that Prime time owns the images and all rights related to them. The images may be used in any manner or media without notifying me, such as websites, publications, promotions, broadcasts, advertisements, posters, and social media posts. I waive any right to inspect or approve the finished images or any printed or electronic material that may be used with them, or to be compensated for them.

Captcha *

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SCROLL DOWN FOR ONLINE REGISTRATION FORM

TWO WAYS TO SIGN UP TODAY!!

CLICK HERE TO DOWNLOAD THE INFORMATION AND PAPER REGISTRATION FLYER

OR SIGN UP ONLINE WITH THE FORM BELOW:

Athlete's Information

Parent/Guardian Info

Health info & waivers

Payment & Enrollment Information

Like this:

SCROLL DOWN FOR ONLINE REGISTRATION FORM

TWO WAYS TO SIGN UP TODAY!!

CLICK HERE TO DOWNLOAD THE INFORMATION AND PAPER REGISTRATION FLYER

OR SIGN UP ONLINE WITH THE FORM BELOW:

Athlete's Information

Parent/Guardian Info

Health info & waivers

Payment & Enrollment Information

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