Intake Application Form

Athlete Intake and Release Form

Please complete this form and return it before your initial assessment. Your information will help us better understand your athletic background and goals.

Personal Information:

First name

Last name

Date of Birth

Gender

Male

Female

Other

Address

Emergency Contact Information:

Medical Information:

Liability Waiver:

I, the undersigned, am voluntarily participating in the activities organized by Out The Chamber Sports. I acknowledge the risks associated with physical training and related activities. I hereby release Out The Chamber Sports and its representatives from any liability for injuries, illnesses, or damages that may occur during or as a result of my participation.

Image and Likeness Release:

I grant Out The Chamber Sports the right to use my image, likeness, or photographs taken during training sessions or events for promotional, marketing, and educational purposes on social platforms, websites, and other media. I understand that my full name or other personal information will not be disclosed without my permission.

Consent and Agreement:

I have read and understood this Athlete Intake and Release Form. I acknowledge that I am participating voluntarily and of my own free will. I consent to the use of my image and likeness as outlined above.

Select a date

Athlete's Signature:

Parent/Guardian (if under 18):

Witness (Organization Representative):

Please fill out the following information:

Physical Characteristics:

Athletic Background:

Medical Information:

Training and Nutrition:

Goals and Objectives:

Coach/Trainer:

Thanks for submitting!