The Shootout Registration Form

Player's First Name
Player's First Name
Field is required!
Player's Last Name
Player's Last Name
Field is required!
Player's Grade
  • - select a option -
  • 3rd
  • 4th
  • 5th
  • 6th
  • 7th
  • 8th
- select a option -
Field is required!
Player's Shirt Size
  • - select a option -
  • Youth Sm
  • Youth Med
  • Youth Lrg
  • Youth XL
  • Adult Sm
  • Adult Med
  • Adult Lrg
  • Adult XL
- select a option -
Field is required!
Parent/Guardian First Name
First Name
Field is required!
Parent/Guardian Last Name
Last Name
Field is required!
Parent/Guardian Address
Your Street Address
Field is required!
Field is required!
Field is required!
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
Field is required!
Parent/Guardian Email
Email Address
Field is required!
Parent/Guardian Cell #
Parent/Guardian Cell #
Field is required!
Relationship to Player
  • - select a option -
  • Mother
  • Father
  • Legal Guardian
- select a option -
Field is required!
Alternate Emergency Contact #
Alternate Emergency Contact #
Field is required!
Liability Waiver:
  1. Guests are subject to all policies and procedures of Starting5. Guests who violate any policy or are deemed by the facility to be acting in any manner that is unacceptable to the facility will be required to leaver immediately.

  2. The facility reserves the right to refuse admission to any guest for any reason and guests residing in a local community (communities within neighboring counties) may not enter the facility as guests more than 3 times.

  3. My signature below indicates full understanding and compliance with the above provisions and the following waiver of liability

I understand that the user of exercise equipment and facilities at Starting5 may subject me to certain physical and medical risks that I agree to assume. I declare myself to be physically sound and suffering no physical impairment, condition or illness that would prevent my safe participation in any exercise program at Net Sports. I further understand that the facility assumes no responsibility for my personal safety and I hereby release the facility, its officers, directors, agents, and employees from any and all liability which may arise directly or indirectly from any damage to me or my property as a result of my participation in exercise and/or use of the facilities at Starting5

Please accept the above waiver to continue
“Type your name” here if you agree with the above statement.
Type your name here
Field is required!